Leslie Larson
White Lake
Summary
Detail-oriented nurse with a strong work ethic and adaptability. Proven success in conducting high-volume chart reviews for appeal determinations, applying clinical guidelines for accurate rationale. Experienced in utilization review for medical necessity and compliance assurance. Expertise in mastering new tasks independently, seeking opportunities in clinical appeals within managed care or insurance sectors.
Overview
38
38
years of professional experience
1
1
Certification
Work History
Clinical Quality Performance Advisor
Clinical Quality Performance Advisor
02.2014 - Current
- Audited individual nurses, tracked and trended audit results, and developed and delivered training to correct deficiencies.
- Served as a medical resource for clinical team and office staff to support effective operations.
- Provides management with objective colleague quality measurements for use in colleague reviews and development
- Reviewed disability appeals and gathered medical documentation for informed decision-making
- Reviews Appeal determination monthly with union, management and team lead for claim action determination
- Established relationships with plant doctors, union representatives, and employment personnel to enhance communication
- Delivered training on new policies and procedures to ensure compliance and understanding
- Prepares reports reflecting scores and trends
- Evaluating and arranging appropriate referral of claims to outside vendors for independent medical evaluation, functional capacity evaluation, and/or related disability activities
- Team resource for medical questions and suggestions regarding complex medical claims
Triage Nurse
IHA Pediatrics
Union Lake
11.2021 - 10.2025
- Provided medical advice adhering to Barton-Schmitt triage nurse pediatric guidelines.
- Triaged patient cases through outbound and inbound calls, creating actionable plans to ensure timely care.
- Escalated emergent medical situations to appropriate care levels.
- Processed critical lab results promptly, alerting providers per protocol requirements.
- Documented comprehensive patient records, ensuring detailed follow-up on outcomes.
- Scheduled appointments while managing logistics and data collection to streamline patient flow.
- Refilled medications in 30-day supplies following established office protocols.
- Took on additional responsibilities as a role model, demonstrating leadership and commitment to team success.
Registered Nurse
Hospice of Michigan
01.2018 - 03.2022
- Demonstrated strong clinical judgment in patient assessments
- Prioritized patient and family needs in care delivery
- Advocated for patients to ensure highest quality of nursing care
- Coordinated care by contacting attending physicians and agencies
- Demonstrated empathy and sensitivity while providing exceptional patient care
- Working as a part of a team to develop and strengthen relationships
- Excellent computer skills; experience with electronic medical records
- Applied understanding of hospice philosophy in patient care
Registered Nurse
Wellbridge Rochester Hills
07.2015 - 07.2017
- Providing nursing assessment, initial plan of care and interventions that optimize patient/family directed comfort and quality of life
- Assessing patient needs for, order, set-up delivery of medical supplies and equipment
- Administer prescribed medications and/or treatments
- Facilitated patient admissions and discharges in a hospital setting
- Dedication to showing empathy and sensitivity in providing outstanding patient care
- Strong team player to deliver EPIC nursing care
- Strong advocate for the patient to promote healing
- Tend to the physical and emotional needs of the chronically incapacitated and patients recovering from surgery to help develop independence and minimize impact of disability
- Delivered care in a sub-acute rehabilitation setting to support patient recovery
Senior Disability Representative
Senior Disability Representative
11.1987 - 09.2014
- Processed claims and determined benefits due under GM disability plan, ensuring compliance and accuracy
- Executed timely payments and applied necessary adjustments, including workers compensation, state plan benefits, and Social Security Disability Income offsets
- Inform claimants of medical documentation required for review including time frames
- Referred cases to onsite medical specialists for claims exceeding established guidelines to facilitate thorough review
- Executed effective decision-making processes in claim assessments
Education
Associates of Science - Nursing
Oakland Community College
Waterford, Michigan04-2014
Skills
- ERISA compliance and healthcare regulations
- Team collaboration and coordination
- Time management and prioritization
- Evidence-based practice guidelines
- Appeal and denial review processes
- Verbal communication skills
- Medical necessity decision-making
- Appeal writing expertise
- Coordination with treating providers
- Medical documentation standards
- Compliance training initiatives
- Critical thinking and analysis
- Monthly GM/union meetings for resolution
- Physician advisor coordination
- Utilization of state guidelines for claim resolution
Certification
• Registered Nurse (RN), Michigan, 4704307573
Personal Information
Title: RN
Timeline
Triage Nurse
IHA Pediatrics
11.2021 - 10.2025
Registered Nurse
Hospice of Michigan
01.2018 - 03.2022
Registered Nurse
Wellbridge Rochester Hills
07.2015 - 07.2017
Clinical Quality Performance Advisor
Clinical Quality Performance Advisor
02.2014 - Current
Senior Disability Representative
Senior Disability Representative
11.1987 - 09.2014
Associates of Science - Nursing
Oakland Community College