Open to opportunities

NaLesha Scott

@naleshascott

Message

Experienced registered nurse specializing in utilization review, case management, and acute care.

United States

Message

What I'm looking for

I seek roles where I can apply utilization review and case management expertise in collaborative, standards-driven teams, with opportunities to mentor and improve clinical quality.

I am a dedicated registered nurse with extensive experience in utilization review, case management, and direct patient care across acute, long-term, and telehealth settings. I ensure compliance with standardized guidelines and regulatory requirements while coordinating care transitions and communicating medical necessity.

My background includes remote utilization review for a major payer, per diem acute/telemetry nursing, COVID investigation and public health data analysis, and skilled home health assessments. I collaborate with interdisciplinary teams and apply Milliman, InterQual, NCQA, URAC, and CMS criteria to optimize patient outcomes and resource utilization.

I have completed a Master of Nursing in Nursing Education and hold BSN and ADN degrees, plus practical nursing and IT certifications, combining clinical expertise with process-driven, data-informed care coordination.

Experience

Work history, roles, and key accomplishments

Current

RN Utilization Review Nurse

Current

UnitedHealthcare

Oct 2020 - Present (5 years 8 months)

Performs remote utilization review and care management across the continuum, ensuring compliance with NCQA, URAC and CMS guidelines and coordinating care transitions to optimize utilization and outcomes.

Utilization Review Case Management NCQA URAC Care Coordination Clinical Documentation

RN Investigator

Tarrant County Public Health

Jun 2020 - Dec 2020 (6 months)

Conducted COVID-19 facility investigations, analyzed exposure data, notified contacts, ensured federal protocols, and maintained 30-day monitoring and reporting in the health department database.

Investigation Data Analysis Contact Tracing Surveillance Compliance Documentation

Staff RN

Northeast Baptist Hospital

Nov 2018 - Sep 2019 (10 months)

Provided acute nursing care on telemetry, cardiac care and med-surgical units, collaborated on individualized care plans per Milliman/InterQual criteria, and completed timely clinical documentation.

Acute Care Telemetry Interdisciplinary Collaboration Clinical Documentation

LVN Fulfillment Nurse

Teladoc

Jun 2015 - Feb 2016 (8 months)

Reviewed member eligibility, routed patients to appropriate telehealth portals, conducted post-consult reviews and education, and managed electronic prescription transmission and record documentation.

Telehealth Eligibility Verification Patient Education Medical Records Clinical Documentation

LVN / Field Care Manager

NurseCore

Nov 2012 - Oct 2015 (2 years 11 months)

Performed OASIS assessments and skilled nursing care, coordinated with interdisciplinary teams, provided patient education on disease management, and documented care to demonstrate medical necessity.

OASIS Assessments Home Health Care Management Patient Education Clinical Documentation