Summary
Overview
Work History
Education
Skills
Additional Information
Timeline
Generic

Lesley Quezada

Summary

Reliable individual bringing 29 years of experience in healthcare environments. Maintains positive relationships with case managers and providers. Remains polished and calm under extreme stress.

Overview

9
9
years of professional experience

Work History

Clinical Care Coordinator LPN

Friday Health Plans
10.2020 - 05.2023
  • Performed prior authorization review of services requiring notification.
  • Submitted cases for criteria failures and helped facilitate resolutions and approvals.
  • Performed admission reviews based for medical necessity based upon Medicare/Medicaid specification.
  • Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
  • Performed admission reviews based for medical necessity.
  • Supervised and maintained all utilization review documentation through Citrix and Care Manager software programs.
  • Proficient with MCG and Up to Date approval criteria.

Medication Refill Nurse

Valley Wide Health Systems
02.2017 - 10.2020
  • Updated patient charts with data such as medications to keep records current and support accurate treatments.
  • Responsible for refilling patient medications electronically by following Company protocols.
  • Reviewed medical charts for pertinent information and accuracy and consistency of medications, lab work, and diagnostic reports.


Long Term Care Facility Nurse

Life Care Centers Of America
09.2014 - 02.2017
  • Maintained detailed records of patient progress, documentation of services and case notes.
  • Updated patient charts with data such as medications to keep records current and support accurate treatments.
  • Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
  • Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
  • Provided patient and family education on available resources and self-care strategies.

Education

Licensed Practical Nurse - Nursing

Trinidad State Junior College
Trinidad, CO
08.1994

Skills

  • Determine Medical Necessity
  • Microsoft Word
  • Physician Consultations
  • Patient Transfers and Transitions
  • Medicare Regulation
  • Documentation Review
  • Interdisciplinary Care
  • Team Meetings
  • Interpersonal and Written Communication
  • Utilization Management
  • Compliance with Regulatory Guidelines
  • Creative Thinking

Additional Information

Nadia Yanez

Friday Health Plans Supervisor

Phone:(719) 588-9336

E-mail: peas.nadia@gmail.com


Sandy Wilcox

Supervisor

Phone: (719) 580-1299

E-mail: sandyjean9979@gmail.com




Timeline

Clinical Care Coordinator LPN

Friday Health Plans
10.2020 - 05.2023

Medication Refill Nurse

Valley Wide Health Systems
02.2017 - 10.2020

Long Term Care Facility Nurse

Life Care Centers Of America
09.2014 - 02.2017

Licensed Practical Nurse - Nursing

Trinidad State Junior College

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