Open to opportunities

Tasha Porter

@tashaporter

I’m a Registered Nurse specializing in utilization review, claims-driven medical necessity determinations, and care coordination.

United States

Message

What I'm looking for

I’m seeking a remote utilization review or case management role where I can apply evidence-based medical necessity criteria, collaborate across providers and payers, and deliver patient-centered, cost-effective outcomes.

I’m a compassionate Registered Nurse with a strong clinical foundation and specialized expertise in claims review, utilization management, and care coordination. I review for medical necessity and level of care using evidence-based criteria to support objective, precise determinations and compliance.

In my current remote RN Case Manager/Utilization Review role, I perform comprehensive clinical reviews to assess medical necessity and appropriate resource utilization. I coordinate with providers, case managers, and interdisciplinary teams while managing multiple cases in fast-paced environments, maintaining accurate documentation for authorization review and care coordination.

Previously, I’ve led outpatient clinic operations as an RN/Charge Nurse, managed hospice patients as a case manager, and completed utilization review for long-term care residents—ensuring discharge planning, symptom-focused care, and continuity of care. I bring clinical assessment, triage, patient education, and quality improvement mindset to every decision, balancing safe outcomes with strategic healthcare cost management.

Experience

Work history, roles, and key accomplishments

Current

RN Case Manager/Utilization Review

Current

CVS

Jan 2026 - Present (5 months)

Conducts comprehensive clinical reviews to determine medical necessity, level of care, and appropriate resource utilization. Coordinates care authorization decisions using evidence-based guidelines while maintaining compliant documentation.

Utilization Review Care Coordination Case Management Clinical Documentation Evidence Based Guidelines Triage HIPAA compliance Interdisciplinary Collaboration

RN / Charge Nurse

RKM Primary Care (FQHC)

Jan 2024 - Dec 2025 (1 year 11 months)

Oversaw daily operations for a combined medical and behavioral health clinic, ensuring efficient workflows and quality patient care. Triaged patients, supported medication and treatment planning, and escalated urgent needs using clinical judgment.

Charge Nurse Duties Patient Triaging Clinical Assessment Behavioral Health Support Medication Management Documentation And Reporting Interdisciplinary Collaboration

RN Case Manager

VitalCaring Hospice

Feb 2023 - Jan 2024 (11 months)

Managed a hospice caseload by completing clinical assessments and developing individualized, comfort-focused plans of care. Coordinated symptom management updates and supported patients and families through end-of-life education and emotional support.

Hospice Care Symptom Management Patient Education Clinical Assessment

Utilization Review Nurse

LTCG

Nov 2019 - Feb 2023 (3 years 3 months)

Performed utilization review for long-term care residents to support appropriate level-of-care decisions and medical necessity. Reviewed documentation for accuracy and compliance, collaborated with care teams, and documented findings to support continuity of care and safe transitions.

Utilization Review Long Term Care Review Compliance Interdisciplinary Collaboration

Registered Nurse

RKM Primary Care (FQHC)

Oct 2018 - Oct 2019 (1 year)

Provided direct outpatient nursing care in a fast-paced clinic, including phone and face-to-face triage to determine severity and prioritize needs. Assisted providers with examinations and procedures, administered medications and immunizations, and maintained accurate clinical documentation.

Clinical Triage Clinical Assessment Telephone Triage Immunizations Patient Education Clinical Documentation

RN, Medical-Surgical/Telemetry

North Oaks Medical Center

Feb 2015 - May 2019 (4 years 3 months)

Provided medical-surgical and telemetry nursing care in an acute hospital setting with a focus on continuous patient monitoring and rapid escalation. Delivered individualized care plans, administered IV therapies and treatments, and educated patients and families on diagnoses and discharge instructions.

Telemetry Acute Care Nursing IV Therapies Clinical Assessment Escalations Patient Education Compliance Documentation