Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:
Professional Summary

Registered Nurse with over three years of acute care nursing on a medical/cardiac/oncology unit. Also have over three years of Case Management experience including discharge planning and utilization review in an acute care setting and case management in an insurance setting. Highly experienced and proficient with telephonic and email communication as well as use of Microsoft office programs, such as Word, Excel and OneNote. Strives to be a strong advocate for patients and their needs while utilizing the best resources available. Strong desire to focus on preventative care and health education.


Registered Nurse in the State of Wisconsin, License number 164264-30.

Eligible and registered for Case Management Certification exam in April 2015 through the Commission for Case Management Certification.

Skill Highlights
  • Strong communication skills
  • Compassionate advocate for patients
  • Computerized charting specialist
  • Familiarity with disease management programs
  • Acute and rehabilitative care
  • Experienced in authorizing procedures
  • Fast learning and adaptive to change
  • Vast knowledge of computer based medical records
Professional Experience
Registered Nurse Case Manager, 09/2013 - Current
Cvs Health Dover, NH,
  • Case Managed over 8000 members of the World Trade Center Health Program, Nationwide Provider Network. Worked on a federally funding contract providing limited medical benefits to Survivors and Responders of the terrorist attacks on 09/11/01 at the World Trade Center, Pentagon and Shanksville, PA crash sites. Performed telephonic communication on a daily basis with members and medical providers. Assisted in developing work instructions for several tasks in the department. Completed documents indicating the relationship between member's exposures at the site and their medical conditions for certification through the National Institute of Occupational Safety and Health. Assisted in coordination of care for member's certified conditions, including Interstitial Lung Diseases, Obstructive Airway, Upper Respiratory, Aerodigestive, Mental Health and Cancer conditions. Used critical thinking skills to authorize appropriate test/procedures while ensuring providers are within the program’s network. Spoke with provider's offices on a daily basis to verify benefits and authorize medical testing/procedures. Requested approval for diagnostic testing/procedures from Medical Director by communicating indications for testing via email. Reviewed medical records for diagnostic and treatment purposes. Used Excel spreadsheets for code verification and authorizations. Participated in weekly team meetings to discuss complex members and their needs from the program. Played a key role in coordinating care for members during mental health crisis situations.
Registered Nurse, Utilization Management Coordinator, 11/2011 - 09/2013
Keystone Human Services Wolcott, CT,
  • Responsible for reviewing hospital charts on a daily basis for medical necessity and discussing with providers whether to admit patients as observation versus inpatient using the Interqual criteria. Spoke directly to insurance companies to authorize hospital stays. Coordinated care for patient's transitioning to home, assisted living facilities, or skilled nursing/rehabilitative facilities. Worked closely with medical providers and other members of the interdisciplinary team to coordinate care for patient's during hospital stay and upon discharge. Main point of contact for Utilization Review for the inpatient behavioral unit. Reviewed behavioral health charts and spoke directly with insurance companies to verify and authorize inpatient behavioral health stays. Developed a tool to communicate with Behavioral Health providers and staff to gather needed information for authorizing hospitalizations. Arranged peer-to-peer reviews with insurance companies and the Behavioral Health provider in the hospital.
Registered Nurse, 06/2008 - 11/2011
Kaplan Development Group Llc Raynham, MA,
  • Cared for patients on a 28 bed, acute care medical/cardiac/oncology unit. Became proficient in the following skills: IV therapy; care of central lines, PICC lines and Ports; tube feedings; urinary catheter insertion; dressing changes; tracheostomy care; chest tube care; reading telemetry rhythms; medication administration. Precepted new RN's as well as numerous student nurses. Served as co-chair of the unit based Quality/Research Council. Served on the system wide Quality Council. Participated in Code Blue situations. Worked with multiple other disciplines to coordinate care for patients. Served as EMR (Electronic Medical Record)f Super-User for the unit.
Licensed Practical Nurse/Registered Nurse, 11/2006 - 06/2008
Caledonia Care And Rehab City, STATE,
  • Cared for residents in a 50 bed skilled nursing facility. Responsible for managing up to 12 employees during a shift. Became charge nurse after one month of orientation as a new nurse. Responsible for calling doctors for orders, entering and signing off on MD orders. Performed medication passes and treatments during shift. Medicare charting, weekly charting and symptom charting on residents. Performed clean wound dressing changes. Supported residents and families during the dying process. Delegated tasks to unlicensed staff members.
Education and Training
Bachelor of Science Degree - Nursing: , Expected in May 2013
Winona State University - La Crescent, MN
Associate Degree - Nursing: , Expected in May 2008
Western Technical College - La Crosse, WI
Bachelor of Science Degree: , Expected in May 2002
University of Wisconsin - River Falls - River Falls, WI

Animal Science with meat animal emphasis, production option


Sigma Theta Tau, National Honor Society of Nursing

LaCrosse District Nurses Association

Wisconsin Nurses Association

American Nurses Association


Review of medical records, use of excel spreadsheets, telephonic communication, critical thinking, knowledge of treatment for medical conditions including mental health and cancer, strong ability to multi-task, adaptive to changing environments, able to work with several different personalities in a team setting, strong communicator.

Additional Information

Nominated for the Optum SuperHero Award in October 2014 for going above and beyond in service to our customers. Key player and main go-to person in the Case Management department during times when leadership is unavailable. Considered an expert on condition reviews and was responsible for training new and seasoned staff on the process change. Consistently asked by supervisor for input on process flows within the department.

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School Attended

  • Winona State University
  • Western Technical College
  • University of Wisconsin - River Falls

Job Titles Held:

  • Registered Nurse Case Manager
  • Registered Nurse, Utilization Management Coordinator
  • Registered Nurse
  • Licensed Practical Nurse/Registered Nurse


  • Bachelor of Science Degree - Nursing
  • Associate Degree - Nursing
  • Bachelor of Science Degree

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