Lesley Dorsey

To work in a position in health care field utilizing my experience in quality management, utilization review, and case management to ensure quality of health care.

Case Management - Vanderbilt Medical Center

(2022-08)

Managing 25 -30 medical patients. I used Aiden as the discharge software and Epic. I collaborated with team members to ensure safe discharge plan.

Case Manager - Meeleo Staffing, Georgetown Hospital - Washington D.C.

(2021-01 - 2022-08)

Worked managing 30-35 medical surgical patients preparing and completing the discharge plan. This was using the Cerner software program and Allscripts.

Case Manager - Meeleo Staffing, Tristar Centennial Medical Center - Nashville, TN

(2020-09 - 2021-01)

Worked as Case Manager for 30 medical surgical and post surgical oncology patients.

Case Manager - Medpro Staffing, Washington Hospital Center - Washington D.C.

(2019-08 - 2020-09)

Worked as a Case Manager using Interqual criteria daily for medical necessity determination. Managed approximately 30-35 cases through the discharge planning process.

Case Manager - University of Virginia Health System - Charlottesville, Virginia

(2011-12 - 2019-03)

Case Manager on Orthopedic/Trauma Unit and Transplant/Surgical Intensive Care and Intermediate Care Unit. This includes surgical patient's providing management of discharge plans and continuity of care. Serving as a liaison between the medical team, insurance companies and health care providers.

Secondary

Reviewer for inpatient nurse case managers, reviewing cases according to InterQual Medical review criteria to ensure medical necessity of admission and continued stay. Serve as a trainer for new inpatient care case managers. Assisting the director with the implementation of the Case Management program.

Registered Nurse Reviewer - Advanced Medical Review - California

(2009-04)

This is part-time contract assignment and work from home. This includes reviewing medical records for quality of care issues. Submitting my decisions on the case with references to current Standard of Care.

Case Manager - Saint Petersburg General Hospital - Saint Petersburg, Florida

(2011-08 - 2011-12)

This is a 16 week travel nurse assignment. Managing the discharge plans for 25 Intensive Care Patients for the hospital. Utilizing the Interqual criteria and Midas program to follow patients in the Intensive Care Unit. Coordinating discharge plans with the physicians, hospital, post-acute care providers to ensure safe discharge from the hospital. Evaluating these patients on a daily basis to ensure the discharge plan is appropriate.

Attending Interdisciplinary Team

Meetings with the personnel involved in the discharge plan.

Utilization Review Coordinator - John Hopkins Hospital - Baltimore, Maryland

(2011-04 - 2011-06)

This was a 13 week travel nurse assignment. Worked as a Utilization Review Coordinator for the 950 bed hospital. This included reviewing 30 medical records daily to ensure payment to the facility. Utilized Morrisey program, InterQual and Milliman criteria to approve hospital stay. Served as a liaison between the insurance companies and facility to provide them with current medical information to ensure payment.

Rehabilitation Admissions Liaison - Laurel Regional Medical Center - Laurel, Maryland

(2011-01 - 2011-04)

This was a 13 week travel nurse assignment. Worked as a liaison with the local hospital to provide admissions to facility. This included three local hospitals and ten outside hospitals. Utilized the review criteria to approve admissions. Reviewed 10-15 cases daily for admission and ensuring payment to the facility by contacting the insurance companies.

Case Manager - Banner Good Smaritian Hospital - Phoenix, Arizona

(2010-10 - 2011-01)

This was a 13 week travel nurse assignment. Worked as a Clinical Care Case Manager for the Neurology Floor implementing discharge plans for 30 patients. Utilized the Allscripts discharge planning system and Interqual Criteria to ensure payment and safe discharge plans. Reviewed each case on a daily basis with Physician Advisor.

Case Manager - Bayonet Regional Medical Center - Hudson, Florida

(2010-02 - 2010-10)

This was a 26 week travel nurse assignment. Worked as a Clinical Care Case Manager negotiating, documenting and implementing the discharge plan for approximately 20-25 patients on a daily basis. This included utilizing a MIDAS software system which tracks the data. Reviewing the medical records using the Interqual Criteria for approval of the inpatient hospitalization.

Clinical Appeals Specialist - Keystone Peer Review Organization - Richmond, Virginia

(2009-10 - 2010-02)

Worked as a Clinical Appeals Specialist for a Peer Review Organization reviewing charts for medical documentation to overtuen denials of payment to the hospitals. This included acute medical care, durable medical equipment, Physical Therapy, Home Health Therapy according to the providers Medicaid Contract. Participated in Appeal Hearings representing the Organization in the Hearing and presenting the case to the Appeals Judge.

Utilization Review Coordinator - Baptist Hospital - Miami, Florida

(2009-04 - 2009-07)

This was a 13 week travel nurse assignment. Worked as a Utilization Review Coordinator for approximately 55 patients on a Medical Telemetry Floor. Utilized the MIDAS software to review for medical necessity and report to the insurance companies and Medicare for payment.

Senior Nurse Case Manager - Anthem Blue Cross Blue Shield of Virginia - Richmond, Virginia

(2006-08 - 2009-02)

Worked as a Complex Care Case Manager coordinating and managing the care of approximately 150 cases. This was telephonic nurse case management. Utilizing the Assessment programs documenting nursing care and interventions. Working with Upper Level Management to ensure URAQ Accreditation and implementing the policies and procedures daily.

Utilization Review Coordinator - University of Virginia Medical Center - Charlottesville, Virginia

(2003-09 - 2007-08)

Reviewed 30-35 cases daily for the University of Virginia Medical Center, Neurology and Epilepsy Unit. This included contacting insurance companies for approval according to Medical Criteria. Reviewing Medicare and Medicaid patients and applying the clinical criteria to ensure payment to the hospital. Worked on past denials to the University to recuperate payment utilizing my past expertise with private insurance companies.

Licensure and Certification Surveyor Long Term Care - Alabama Department of Public Health - Montgomery, Alabama

(2001-12 - 2002-12)

Worked for the State of Alabama Public Health Department surveying Nursing Homes using Medicare Federal Regulations. This included interviewing, analyzing medical records and observing the direct care of nursing home residents. The information would be combined to produce a legal report and submitted to the Nursing Homes for Corrective Action Plans.

Quality Assurance Specialist - Gift of LIfe Foundation - Montgomery, Alabama

(1999-05 - 2000-04)

Worked as a consultant for the Gift of Life Foundation. Developed and implemented a Quality Assurance Program for the Gift of Life Foundation, State of Alabama Medicaid Program. Reviewed providers in the field and submitted the reports to the State of Alabama for approval.

Utilization Review Coordinator/ Clinical Care Coordinator - Blue Cross and BlueShield - Montgomery, Alabama

(1993-02 - 1999-04)

Conducted on-site medical audits for the Blue Cross and Blue Shield of Alabama in four area hospitals ranging from 250 beds to 450 beds. Served as the Blue Cross and Blue Shield on-site case manager in the Baptist South Montgomery Hospital. Responsibilities included negotiating cost efficient health care with area providers. Analyzed and developed statistical reports regarding health care to ensure cost efficient health care for the Blue Cross and Blue Shield of Alabama members.

Quality Assurance Specialist - Alabama Medicaid Agency - Montgomery, Alabama

(1991-06 - 1993-02)

Conducted on-site medical record reviews for the State of Alabama Medicaid Agency, Managed Care Program. This required travel to various Health Maintenance Organizations throughout the state. Prepared policies and procedures for the State of Alabama Medicaid Program. Reviewed the program to ensure that quality of care was provided to the Medicaid patients.

Charge Nurse for Medical Surgical Floor - Veterans Hospital - Montgomery, Alabama

(1990-12 - 1991-06)

Charge Nurse Evening Shift for the Veterans Hospital, Montgomery, Alabama. Assigned staff to patient care on an Acute Medical Surgical Care Floor. Managed approximately 15 staff members to ensure quality of care to 50 patients on floor.

Case Manager - Med-Manage - Mobile, Alabama

(1989-02 - 1990-10)

Supervised and coordinated the medical care for twenty-five injured workers in the Central region of Alabama. Worked with a workman’s compensation insurance companies. This was to ensure the medical care was communicated to physicians, insurance adjusters and attorneys. Traveled the northern and central area of Alabama recruiting and training case managers. Served as the Marketing Representative for central and northern portion of Alabama.

Surgical Staff Nurse - Martha Jefferson Hospital - Charlottesville, Virginia

(1985-11 - 1989-06)

Responsible for the patients, staff and coordination of a surgical suite at Martha Jefferson Hospital, Charlottesville, Virginia. Supervised the operating room, completing all forms of documentation, working as a scrub technologist on many procedures.

Medical Surgical Staff Nurse - University of Virginia - Charlottesville, Virginia

(1985-12 - 1986-11)

Worked as a medical surgical staff nurse for the post surgical patients at the University of Virginia Medical Center. Duties included primary care nursing for approximately 12 post surgical patients. This included status post kidney transplant patients.

Master of Public Administration - Health Care - Auburn University of Montgomery (1993-12)

Associate of Science - Nursing - Troy State School of Nursing (1985-12)

Bachelor of Arts - Criminal Justice Administration, Minors, Business Administration and Psychology - University of Alabama (1979-05)

College Preparatory High School Diploma - Jefferson Davis High School (1975-05)