K imberly Clavelle

**** ******* *** **

Houston TX, 77008

832-***-****

Education: G raduated with 3.8 GPA from Houston Community LVN program in 1983.

Yellow belt six sigma certificate.

Skills, and Experience: Case management, Home health, Disease management, Hospice,

H ED IS, Quality Measures, EMR’s, SNF, Pediat rics, Geriat rics, Claims, Prior authorization,

Payroll, and billing.

E mployment:

Caring Professional Home homecare, and PAS: 12/13 – present: D irector of Provider

Services. Responsible for management of caregivers in 4 independent living communities,

admissions, scheduling, handling referrals, and all after hour calls.

U niversal American/Texan Plus: 4/2011- 12/13. Case management of members with

chronic conditions such as CAD, CHF, DM, and HTN. Post hospital assessments of

members following planned admissions and ER visits. Prior authorization of powered

mobility devices. Coordination of care including services, such as DME, home health, and

M D appointments. Back up to team lead to help with distribution of tasks. Case

management of CHF remote monitoring program.

Paragon/New Centu ry Hospice : 8/2010-2/2011: Hospice Visits, QA, and chart audits.

Scheduling of H HA's visits. I was responsible for t raining, and inservicing of H HA's.

A medisys Home health 9/09 to 7/10: I did Medicare skilled nursing visits which included

wound care, and disease management. I did patient, care giver teaching, and reported any

change in condition to the RN, and MD.

Special Kids Kare 02/09 9/09: Total patient care of medically fragile children. Responsible

for total patient care of t rached, and vent dependent children.

We care kids care 09/08 to 02/09: Private duty care of medically fragile children. The

patients were t rached, and vent dependent. Required G-button feedings, and medications.

Maxim Healthcare 09/03 to 09/08: Private duty care of chronically ill children who were

t rached, and vent dependent. Was responsible for total patient care including G-Button

feedings, and medications.

Ashton Parke Care Center 01/08 to 05/08: 100 bed long term care facility. I worked as a

PPS/MDS/Tile nurse. I verified admission orders with MD, and did data entry for

medication, and t reatment records. I was responsible for all discharge planning. I did all

Medicare, and Medicaid assessments to establish reimbursement rate.

Epic Healthcare 01/07 to 01/08: Private duty of chronically ill patients who were vent, and

t rach dependent. I was responsible for total patient care including all enteral feedings, and

meds.

United/Americhoice 11/04 to 05/05: I worked in a prior authorization call center. I was

responsible for prior authorization of hospital admissions, surgical procedures, pain

management, home health, and hospice. I utilized M illiman, and Intequal criteria to

determine approval. Cases I was unable to approve where forwarded to the Medical

D irector for consideration.

Afton Oaks Nursing Home 04/04 to 06/04: 150 bed long-term care facility. I worked as a

M DS/PPS coordinator. I was responsible for Medicaid, and Medicare assessments.

Responsible for care planning, and lab t racking.

Briarwood nursing home 02/04 to 04/04: This is a 220 bed long-term care facility. I

worked as a MDS coordinator. I was responsible for Medicaid, and Medicare assessment.

Responsible for care planning, and doing on-call.

Houston Hospice 09/02 to 09/03: I worked as a hospice nurse for pediat ric, and adult

patients. Did field visits, and on-call. I was responsible for assisting with pain

management/palliative care.

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