Tasha Porter
Ponchatoula,LA
Summary
Compassionate Registered Nurse (RN) with a strong clinical foundation and specialized expertise in claims review, utilization management, and care coordination. Proficient in evaluating medical necessity, interpreting insurance policies, and applying evidence-based criteria to ensure fair and accurate determinations. Recognized for fostering effective collaboration among healthcare providers, payers, and patients to achieve optimal quality outcomes while strategically managing healthcare costs. Committed to enhancing patient care through comprehensive assessments and informed decision-making in complex healthcare environments.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
LTCG
11.2019 - 02.2023
- Evaluated long-term care insurance claims by reviewing medical records, care plans, and physician certifications against policy provisions.
- Applied benefit eligibility criteria, including Activities of Daily Living (ADLs) and cognitive impairment assessments, to make fair determinations.
- Verified provider licensure, facility qualifications, and care setting compliance with policy requirements.
- Reviewed and adjudicated claims for home health, assisted living, nursing home, and hospice care services.
- Interpreted benefits, coverage limitations, and medical necessity guidelines to make fair and timely claim determinations.
- Partnered with providers, policyholders, and internal teams to clarify coverage determinations and resolve disputes.
RN Case Manager
VitalCaring Hospice
02.2023 - 01.2024
- Improved patient comfort by providing compassionate end-of-life care and addressing individual needs.
- Collaborated with bereavement specialists to provide ongoing grief support for families after the loss of their loved ones.
- Served as patient advocate during care conferences with physicians, therapists, social workers, and other team members.
- Assessed patients' physical, emotional, spiritual, and psychosocial needs to continually adapt care plans accordingly.
- Enhanced family support by offering guidance, resources, and emotional assistance during difficult times.
- Provided high level of quality, compassionate care to patients and caregivers during each nursing shift.
Registered Nurse
RKM Primary Care (FQHC)
01.2024 - Current
- Developed strong therapeutic relationships with patients through empathy, cultural sensitivity, and open communication channels that foster trust.
- Facilitated continuity of care by effectively communicating with primary healthcare providers regarding pertinent clinical findings and collaborating on optimal treatment strategies.
- Reduced medication errors by meticulously verifying all orders, administering medications as prescribed, and diligently monitoring for adverse reactions or complications.
- Educated patients, families and caregivers about conditions and treatments.
- Performed triage on incoming patients and determined severity of injuries and illnesses.
- Increased efficiency in the unit by effectively prioritizing tasks, managing time, and delegating responsibilities when appropriate.
Registered Nurse, Medical-Surgical/Telemetry Unit
North Oaks Medical Center
02.2015 - 05.2019
- Utilized critical thinking skills to prioritize nursing interventions based on patients' acuity levels and individual needs.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Improved patient outcomes by implementing evidence-based nursing interventions and individualized care plans.
- Facilitated patient transitions between different levels of care, ensuring continuity of services and minimizing disruptions in treatment plans.
- Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
Education
Bachelor of Science - Nursing
Southeastern Louisiana University
12-2027
Associate of Science - Nursing
Our Lady of The Lake College
05-2014
Skills
- Complex Problem-solving
- HIPAA compliance
- Clinical assessment
- Quality improvement
- Records analysis
- Documentation and reporting
- Interpersonal and written communication
- Discharge planning
- Utilization management
- Managed care
- Medicare
- Medicaid
Certification
- Registered Nurse (RN), LA, RN146084, Nurse Licensure Compact
- Basic Life Support (BLS)
Timeline
Registered Nurse
RKM Primary Care (FQHC)
01.2024 - Current
RN Case Manager
VitalCaring Hospice
02.2023 - 01.2024
Utilization Review Nurse
LTCG
11.2019 - 02.2023
Registered Nurse, Medical-Surgical/Telemetry Unit
North Oaks Medical Center
02.2015 - 05.2019
Associate of Science - Nursing
Our Lady of The Lake College
Bachelor of Science - Nursing
Southeastern Louisiana University
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