CLAIRE BOLON, M.D.
Newbury,VT
Summary
Professional in medical field with proven track record of leading clinical teams, developing healthcare strategies, and improving patient outcomes. Skilled in utilization management, regulatory compliance, and collaboration. Strong focus on team collaboration and achieving results with adaptability and reliability. Known for excellent communication, problem-solving, and leadership abilities.
Overview
35
35
years of professional experience
1
1
Certification
Work History
Medical Director, Transactional Management
MVP Healthcare
Remote
09.2019 - Current
- Lead Utilization Management (UM) primary reviews and appeals across all lines of business, including peer-to-peer requests
- Serve as escalation point for complex provider/member complaints and UM-related concerns; support prior authorization evaluations
- Provide medical director oversight for Quality complaints and SIU cases
- Recruit and train new medical directors on end-to-end UM processes
- Collaborate with UM nurses, appeals coordinators, provider access, contracting, quality, and care coordination teams for complex cases
- Partner with Policy team on medical policy development and regulatory reviews
- Manage medical director on-call and OOO schedules
- Conduct biannual quality control and interrater reliability evaluations for BH and PH medical directors
Medical Director
MVP Healthcare
Remote
09.2019 - 09.2021
Co-Owner of Upper Valley Pediatrics (UVP), PLLC & Primary Care Pediatrician
Upper Valley Pediatrics (UVP), PLLC
VT
12.2011 - 09.2019
Primary Care Pediatrician
Ammonoosuc Community Health Services
Woodsville, NH
10.2007 - 12.2011
Primary Care Pediatrician
Cottage Hospital Health Services
Woodsville, NH
09.1999 - 01.2007
Medical Director, Inpatient Pediatrics
Lehigh Valley Hospital
Allentown, PA
01.1993 - 01.1999
Director Inpatient Pediatrics
Mercy Catholic Medical Center
Darby, PA
01.1991 - 01.1993
Education
Master of Science - Chemistry
Siena College
Loudonville, NY01-1984
Residency (P1-2 & P1-3) - Pediatrics
Columbus Children’s Hospital (affiliated with Ohio State Univ.)
Columbus, OH01-1991
Internship (P1-1) - Pediatrics
Columbus Children’s Hospital
Columbus, OH01-1989
M.D. - undefined
SUNY Health Science Center
Syracuse, NY01-1988
Skills
- Utilization Management
- Training & Education
- Leadership
- Communication
Affiliations
- 2000-2019 Adjunct Assistant Professor of Pediatrics Department of Pediatrics Dartmouth Medical School, Hanover, NH
- 1999-2015 Member, Active Staff, Pediatrics Cottage Hospital, Swiftwater Road, Woodsville, NH 03785
- 1994-1999 Assistant Professor of Clinical Pediatrics Department of Pediatrics Pennsylvania State University / Hershey Medical College
Certification
- Active: Vermont & New York
- Board Certified in Pediatrics, 1992
- Recertified, 1998, 2005, 2013, 2017, & 2022
Timeline
Medical Director
MVP Healthcare
09.2019 - 09.2021
Medical Director, Transactional Management
MVP Healthcare
09.2019 - Current
Co-Owner of Upper Valley Pediatrics (UVP), PLLC & Primary Care Pediatrician
Upper Valley Pediatrics (UVP), PLLC
12.2011 - 09.2019
Primary Care Pediatrician
Ammonoosuc Community Health Services
10.2007 - 12.2011
Primary Care Pediatrician
Cottage Hospital Health Services
09.1999 - 01.2007
Medical Director, Inpatient Pediatrics
Lehigh Valley Hospital
01.1993 - 01.1999
Director Inpatient Pediatrics
Mercy Catholic Medical Center
01.1991 - 01.1993
Residency (P1-2 & P1-3) - Pediatrics
Columbus Children’s Hospital (affiliated with Ohio State Univ.)
Internship (P1-1) - Pediatrics
Columbus Children’s Hospital
M.D. - undefined
SUNY Health Science Center
Master of Science - Chemistry
Siena College
Professional Associates
- American Academy of Pediatrics
- Diplomate of the National Board of Medical Examiners