Claudia O’Connor
Fairfax,VA
Summary
Proven Travel RN Case Manager with 25+ years of Clinical Nursing Experience 18+ years Acute Case Manager experience; including 6+ years Travel CM experience. Areas of expertise include Utilization Management and Discharge Planning. Units of expertise include ICU, M/S, Telemetry, ED, Trauma, Oncology, Psych, Heart and Lung Transplant, Cardiology, Surgery, LTACH, Acute Rehab, Sub-Acute, and SNF.
Overview
25
25
years of professional experience
2
2
Certification
Work History
Neurology RN Team Lead
Inova Fairfax Ambulatory Neurology Clinic
Fairfax, VA
12.2023 - 03.2025
- Developed policies, systems work documents, and checklists to confirm efficacy.
- Oversee 1525 staff members in both Alexandria and Fairfax East clinics
- Responsibilities include scheduling, payroll, coordinating staff education.
- Re-education of regulatory standards and practices.
- Auditing to ensure compliance and performing PIPs.
Travel RN Case Manager
Inova Fairfax Hospital
Falls Church, VA
05.2022 - 12.2023
- Company Overview: 923 Bed Level I Teaching/Trauma Facility
- Successfully completed a 13-week contract followed by two extensions
- Completed Discharge Planning throughout the entire hospital using Epic and Allscripts
- 923 Bed Level I Teaching/Trauma Facility
Travel RN Case Manager
UC San Diego, Hillcrest
San Diego, CA
01.2022 - 04.2022
- Company Overview: 422 Bed Level 1 Teaching/Trauma Facility
- Successfully completed a 14-week assignment as a Utilization Review and Discharge Planning Nurse in the Emergency Department
- 422 Bed Level 1 Teaching/Trauma Facility
Travel RN Case Manager
Inova Fairfax Hospital
Falls Church, VA
02.2021 - 12.2021
- Company Overview: 923 Bed Level I Teaching/Trauma Facility
- Successfully completed a 13-week contract followed by three extensions
- Completed Discharge Planning throughout the entire hospital using Epic
- 923 Bed Level I Teaching/Trauma Facility
RN Care Coordinator-Telemetry/Stroke
El Camino Hospital
Mountain View, California
05.2016 - 03.2020
- Company Overview: 443 Bed Short Term Acute Facility
- Demonstrated knowledge of utilization management and medical necessity through appropriate use of guidelines (InterQual)
- Patient population included trauma, stroke, CHF, sepsis, respiratory failure
- Responsibilities included SNF/ARU placements, arranging home health, home oxygen, new HD, acute care transfers, medical respite placements, and providing community resources to patients and families
- Facilitated safe discharge plans by collaborating with a multi-disciplinary team (MD, PT/OT/SW/dieticians) to prevent sub-par patient outcomes and re-admissions
- Educated physicians, clinical managers, and staff about the importance of documentation to facilitate re-imbursement from Managed Care Organizations (MCOs)
- 443 Bed Short Term Acute Facility
Float RN Case Manager
Stanford Hospital and Clinics
Stanford, California
01.2015 - 05.2016
- Company Overview: 477 Bed Level I Teaching/Trauma Facility
- I worked in Cardiac Surgery, Cardiology, GI/Liver/Hepatology, Pulmonary/Heart/Lung Transplant, Vascular Surgery, Critical Care, Hematology, Oncology, Bone Marrow Transplant, ENT and Plastics, Emergency Room, Neuro/Stroke, and Neurosurgery
- Coordinated complex discharge planning needs for patients in rural areas i.e., arranging oxygen for patients with pulmonary HTN living distances of 5-6 hours from the treatment hospital
- Reviewed appropriateness of admission, level of care, and discussed with doctor’s discharge disposition when medically cleared
- Communicated daily with MCO’s requesting clinical information to assure hospital reimbursement
- 477 Bed Level I Teaching/Trauma Facility
Travel RN Case Manager
Stanford Hospital and Clinics
Stanford, California
01.2014 - 07.2014
- Company Overview: 477 Bed Level I Teaching/Trauma Facility
- 477 Bed Level I Teaching/Trauma Facility
RN Travel Nurse Case Manager
St. Michaels Medical Center
Newark, New Jersey
01.2014 - 07.2014
- Company Overview: 147 Bed Academic Facility
- Collaborated with Physicians, Social Workers, Support Liaisons, and other interdisciplinary team members to assess, plan, and coordinate patient care needs
- Provided consultation and education to members of the healthcare team, hospital departments, service lines, community agencies, and providers
- 147 Bed Academic Facility
Registered Nurse Liaison (Acute Rehab)
Kessler Institute for Rehabilitation
West Orange, New Jersey
11.2011 - 12.2013
- Completed preadmission assessments in a timely and thorough manner to justify admission decisions
- Coordinated with the Admission Department through effective communication providing appropriate documentation, including pre-admission assessments and patients clinical and insurance information
- Collaborated with Traumatic Brain Injury and Spinal Cord Coordinators, Nursing, Pharmacy, and Medicine on complex referrals to expedite appropriate admissions
- Educated potential patients and families about acute rehabilitation and benefits of various programs
RN-External Case Manager (Sub-Acute Rehab/Long Term Care)
Omni Health Systems of New Jersey
West Orange, New Jersey
10.2010 - 11.2011
- Company Overview: St
- Barnabas Medical Center/St
- Cloud Health Care Center/Kessler
- Performed as a liaison for sub-acute facility in acute care hospitals
- I interacted with Case Managers and families daily to facilitate transition of care of patients
- Communicated daily with the Admissions Director, informed peers of referrals and expected admissions; and with the business office, provided financial information necessary for rehab eligibility and/or long-term care
- Met with Medical Directors and physicians monthly to market facility and programs offered
- St
- Barnabas Medical Center/St
- Cloud Health Care Center/Kessler
RN-Case Manager (Oncology/Medical-Surgical)
Saint Barnabas Health Care Systems
Belleville, New Jersey
09.2008 - 10.2010
- Company Overview: 342 Bed Academic Facility (Clara Maass Medical Center)
- Conducted daily utilization review of approximately twenty-five cases
- Presented patient case summaries to the Physician Advisor, Vice President of Nursing, and Director of Case Management
- Reviewed Medicare patient admissions against Medicare criteria to certify hospitalization and communicated daily with managed care organizations informing carrier of patient’s health status, current treatment, and discharge plan
- Coordinated patient’s care with dieticians, social workers, physical/speech therapists, nurses, and doctors; analyzed their evaluations and recommendations, and integrated their recommendations into a realistic and measurable discharge plan
- Discussed and coordinated follow-up services such as surgery, radiation, and/or chemotherapy treatments
- Addressed palliative care needs, advanced directives, home care services, medication therapy, and short- or long-term placement needs with patient, family, and multi-disciplinary team
- 342 Bed Academic Facility (Clara Maass Medical Center)
Clinical Nurse Project Manager (Medical Management)
Health Insurance Plan of Greater New York
New York, New York
07.2005 - 09.2008
- Reviewed and incorporated Medicare, Medicaid, URAC (Utilization Review Accreditation Commission) and NCQA (National Committee for Quality Assurance) criteria into health plan operational processes and workflows to assure compliance within the organization
- Conducted monthly internal Sarbanes-Oxley audits of the health plan claims department to ensure monies were paid to providers appropriately and in a timely manner
- Audited results presented to the Care Management Committee bi-annually
- Conducted quarterly denial, appeal, and medical necessity review audits of all Care Management departments to ensure decision making processes and documentation met regulatory and accreditation standards
- Presented audit results to the Department heads and developed corrective action plans where areas of deficiency were noted
- Presented results to the Care Management Committee quarterly
- Developed and distributed Inter-Rater Reliability Audits to Care Management Departments to monitor consistency in decision making process
- Presented audit results to the department heads and developed corrective action plans where areas of deficiency were noted
- Presented results to the Care Management Committee quarterly
- Investigated high dollar claims (>$100,000.00) by hospitals for services provided to health plan members
- Presented information to the Medical Director of Medical Management and Managing Director of Health Care Operations
Prior-Authorization Nurse (Care Management)
Health Insurance Plan of Greater New York
New York, New York
12.2003 - 07.2005
- Utilized InterQual, Bischel, Medicare, Medicaid, and internal health plan guidelines to make medical necessity decisions
- Applied knowledge of ICD-9, CPT-4 codes, DRG’s, and per diem rates to make timely decisions
Registered Travel Nurse
All Care Nursing Agency
Plainview, New York
08.2000 - 12.2003
- Created and implemented care plans to address physical exam results, diagnoses, co-morbidities, disease prevention, and medication usage
- Discussed in plain language to the patient their disease process, implications, and reasons for compliance
- Worked on hospital units including medical-surgical, telemetry, neurology, and same day surgery in both New York and New Jersey hospitals
Education
Bachelor of Science - Nursing
Molloy College
Rockville, NY05.2007
Associate of Science - Nursing
Nassau Community College
Garden City, NY06.1998
Skills
- Epic charting
- Utilization management
- Regulatory compliance
- Discharge planning
- Care coordination
- Case management
Certification
- Commission for Case Manager Certification (CCM)
- American Board of Managed Care Nursing (CMCN)
- BLS Certification
Licenses
- RN Compact License, 37 states
- California RN License, California
- New York RN License, New York
Systems Experience
- Epic
- Cerner
- Midas
- McKesson
- Sorian
- Allscripts
- Milliman
- InterQual
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference
Work Type
Part TimeWork Location
RemoteHybridImportant To Me
Healthcare benefitsWork from home optionCompany CultureTimeline
Neurology RN Team Lead
Inova Fairfax Ambulatory Neurology Clinic
12.2023 - 03.2025
Travel RN Case Manager
Inova Fairfax Hospital
05.2022 - 12.2023
Travel RN Case Manager
UC San Diego, Hillcrest
01.2022 - 04.2022
Travel RN Case Manager
Inova Fairfax Hospital
02.2021 - 12.2021
RN Care Coordinator-Telemetry/Stroke
El Camino Hospital
05.2016 - 03.2020
Float RN Case Manager
Stanford Hospital and Clinics
01.2015 - 05.2016
Travel RN Case Manager
Stanford Hospital and Clinics
01.2014 - 07.2014
RN Travel Nurse Case Manager
St. Michaels Medical Center
01.2014 - 07.2014
Registered Nurse Liaison (Acute Rehab)
Kessler Institute for Rehabilitation
11.2011 - 12.2013
RN-External Case Manager (Sub-Acute Rehab/Long Term Care)
Omni Health Systems of New Jersey
10.2010 - 11.2011
RN-Case Manager (Oncology/Medical-Surgical)
Saint Barnabas Health Care Systems
09.2008 - 10.2010
Clinical Nurse Project Manager (Medical Management)
Health Insurance Plan of Greater New York
07.2005 - 09.2008
Prior-Authorization Nurse (Care Management)
Health Insurance Plan of Greater New York
12.2003 - 07.2005
Registered Travel Nurse
All Care Nursing Agency
08.2000 - 12.2003
Bachelor of Science - Nursing
Molloy College
Associate of Science - Nursing
Nassau Community College
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