Melissa Van Leeuwen
Sioux Falls
Summary
Dynamic Senior Utilization Management Specialist at Sanford Health with expertise in insurance verification and interdisciplinary collaboration. Proven track record in enhancing service appropriateness and achieving timely authorizations. Skilled in navigating healthcare regulations while mentoring teams to elevate care quality and compliance. Committed to continuous quality improvement in patient outcomes.
Critical thinker and problem-solver due to dynamic patient care planning and understanding of Medicare guidelines. Known for having great rapport with providers and insurance carriers.
Overview
21
21
years of professional experience
Work History
Senior Utilization Management Specialist
Sanford Health
04.2018 - Current
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Devise or identify solutions for irregular requests and issues.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Supervised and maintained all utilization review documentation through EPIC.
- Performed prior authorization review of services requiring notification.
Pediatric Nurse Manager
Sanford Health
08.2012 - 04.2018
- Maintained current knowledge of healthcare practices and developments to provide evidence-based care.
- Mentored junior nurses to promote professional development and enhance overall quality of care.
- Collaborated with multidisciplinary teams to provide optimal patient care.
- Complied with ethical and legal standards to maintain professional integrity and meet regulatory requirements.
- Managed nurses and patient care assistants on the pediatric medical, surgical and oncology floors who provided care to pediatric patients.
Registered Nurse, PICU
Sanford Health
11.2010 - 08.2012
- Guided patients, caregivers, and family members on plans of treatment and helpful resources available locally to support care.
- Administered medications and treatments as ordered by physician.
- Trained and coached new employees on protocols and best practices to promote ideal patient outcomes.
- Conducted patient assessments, recorded vitals, and analyzed records and charts to define care requirements.
- Coordinated with healthcare staff from various disciplines to devise, carry out, and manage personalized care plans to benefit patient health and recovery.
Travel Registered Nurse, NICU
AMN Healthcare
09.2009 - 09.2010
- Assessed, evaluated, and cared for neonate and pediatric patients.
- Assessed and documented changes in patient's condition and prepared patient for transfer to higher level of care.
- Conducted patient assessments, recorded vitals, and analyzed records and charts to define care requirements.
- Administered medications and treatments as ordered by physician.
- Coordinated with healthcare staff from various disciplines to devise, carry out, and manage personalized care plans to benefit patient health and recovery.
- Guided patients, caregivers, and family members on plans of treatment and helpful resources available locally to support care.
- Applied effective time management techniques to meet tight deadlines.
Registered Nurse NICU
Mercy Medical Center, Des Moines, CHI Health
05.2004 - 09.2009
- Assessed, evaluated, and cared for neonate and pediatric patients.
- Triaged patients and delegated treatment needs to qualified staff and specialized departments.
- Assessed and documented changes in patient's condition and prepared patient for transfer to higher level of care.
- Administered medications and treatments as ordered by physician.
- Guided patients, caregivers, and family members on plans of treatment and helpful resources available locally to support care.
- Trained and coached new employees on protocols and best practices to promote ideal patient outcomes.
- Applied effective time management techniques to meet tight deadlines.
- Participated in team projects, demonstrating an ability to work collaboratively and effectively.
Education
Associate of Science - Nursing
Mercy College of Health Sciences
Des Moines, IASkills
- HIPAA compliance
- Healthcare regulations
- Quality improvement
- Insurance verification
- Interdisciplinary collaboration
- Utilization review
- Medicare
- Utilization management
- Medicaid
Timeline
Senior Utilization Management Specialist
Sanford Health
04.2018 - Current
Pediatric Nurse Manager
Sanford Health
08.2012 - 04.2018
Registered Nurse, PICU
Sanford Health
11.2010 - 08.2012
Travel Registered Nurse, NICU
AMN Healthcare
09.2009 - 09.2010
Registered Nurse NICU
Mercy Medical Center, Des Moines, CHI Health
05.2004 - 09.2009
Associate of Science - Nursing
Mercy College of Health Sciences
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