Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • Home: (555) 432-1000
  • Cell:
Professional Summary

Dynamic and Ambitious Registered Nurse bringing 20 years of treating patients and coordinating care with other healthcare staff. Proven history of leveraging critical thinking, analysis and medical knowledge to deliver superior care in high-pressure environments. Prioritizes clinical and operational tasks in fast-paced emergency medicine settings.

  • Excellent communication skills both verbal and written skills
  • Possess planning, organizing, conflict resolution, negotiating, and essential interpersonal skills
  • Diabetes education and training
  • Previous Prior Authorization experience
  • Utilization Review/Management experience
  • ICD-10, CPT coding knowledge/experience
  • Systems knowledge – Medical Management Systems
  • PC proficiency: MS Office (Word & Excel)
  • Experience with CMS criteria, InterQual
  • Highly organized and able to prioritize and follow through on multiple projects in timely manner
  • Fluent in Conversational medical French and Spanish, and Creole
  • Works with minimal guidance; seeks guidance on only most complex tasks
Work History
Registered Nurse/Utilization Management , 01/2018 to 01/2021
Onward HealthcareDes Moines, IA,
  • Exceptional communications abilities
  • Two ( +) years of Utilization Management experience
  • Demonstrates sensitivity to culturally diverse situations, members, and clients
  • Adheres to quality assurance standards and all utilization management policies and procedures
  • Reviews and processes authorization review requests for determinations within regulatory turnaround time
  • Acts as resource and decision making party to ensure that clinically sound decision is administered. Works collaboratively with other departments to implement policies and procedures that directly impact specialties benefit
  • Fielded telephone inquiries on authorization details from plan members and medical staff.
  • Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
  • Escalated requests for non-standard services to Medical Directors and personnel in their areas of expertise for secondary reviews
  • Edited letters and written material for correspondence. Allowed members to know process of what was approved or not for services for their records
  • Communicated with executives about consistent customer issues.
  • Authorized surgical and Inpatient admission requests in accordance with applicable plan guidelines.
  • Performed prior authorization review of services requiring notification..
  • Knowledgeable in CPT and ICD-10 coding principles, government regulations and third-party billing rules.
Registered Nurse- Home Health, 09/2017 to 12/2017
Elderwood At WaverlyGillett, PA,
  • Traveled to patients' homes on daily basis to assess health conditions and provide superior level of nursing care. ( Case loads varied daily and bi-weekly from 4 members every other day for Intravenous medication administrations; 3-5 admission assessments every 2-3 days)
  • Assistance and home training to patients families on home care; how to perform blood sugar tests when nurse was not available; how to monitor changes in patients behavior, both physically and mental;
  • Diabetes education to patient and families in English and Creole, and sometimes Spanish translations, to familiarize them on what to look for and do if their loved ones were having episodes of hypo/hyperglycemic events.
  • Educated patients and families on blood pressure monitoring. How to properly take blood pressures and when to contact 911 or primary
  • Provided complete care to home health patients, including physical assessments, medication and chronic disease management.
  • Advised and coached patients progressing from hospitals, rehab facilities and other medical organizations to at-home treatment settings.
  • Incorporated therapeutic, rehabilitative and nursing goals into detailed, individualized care plans based on diagnoses.
  • Assessed patients' health conditions and asked appropriate questions to better understand current feelings.
  • Took samples such as blood and urine to complete diagnostic and routine assessment tests.
  • Delivered oral medications, intramuscular injections and IV fluids to mitigate or resolve patient symptoms.
  • Introduced changes to patient care plans based on regular evaluations and patient changes.
  • Gathered and evaluated quality assurance data to identify issues and improve process efficiency.
  • Carefully handled and disposed of biological hazardous materials following strict safety procedures to avoid contamination.
  • Proved successful working within tight deadlines and fast-paced atmosphere.
  • Used Microsoft Word and other software tools to create documents and other communications ( for individual clients in native languages of Creole, French, and Spanish)
Licensed Practical Nurse, 05/XXX0 to 04/2014
Miami Jewish Health Systems-Douglas Gardens HospitalCity, STATE,
  • Applied interpersonal communication skills to comfort and counsel patients and families throughout care process.
  • Educated clients, patients and caregivers on medical diagnoses, treatment options, chronic disease self-management and wound management.
  • Diabetes Education and support for patients as well as training staff. CNA's trained in taking blood sugars routinely to assist nurses when units were short staffed
  • Collaborated with interdisciplinary team of healthcare and social service providers, including MDS, RN's, Dietician and MD/ APRN to address patients' needs through effective intervention and care planning.
Bachelor of Science: Nursing, Expected in
Capella University - Minneapolis, MN

Newly -enrolled in BSN Program

Associate of Science: Nursing, Expected in 2013
Dade Medical College - Miami, FL,

American Nurses Association Member July 2014-Present Florida Nurses Association July 2014-Present

  • Licensed Registered Nurse- State Of Florida Board Of Nursing
  • Expires April 30, 2023
  • Clear/ Active
  • Multistate Registered Nurse
  • FEMA Training Certifications in:
  • General Practice Guidelines Covid-19 Vaccines
  • Covid-19 Training Guidelines in Storage, Handling, and Administration of Vaccine
  • Training with Janssen Covid-19 Vaccine ( Johnson & Johnson);
  • Moderna Covid-19 Vaccine and Pfizer-BioNtech Vaccine and Guidelines

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School Attended

  • Capella University
  • Dade Medical College

Job Titles Held:

  • Registered Nurse/Utilization Management
  • Registered Nurse- Home Health
  • Licensed Practical Nurse


  • Bachelor of Science
  • Associate of Science

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