Holly Gillard
Austin,TX
Summary
Registered Nurse with experience in pediatric case management, clinical documentation review, care coordination. Skilled in evaluating medical necessity, managing authorizations, and ensuring compliance with regulatory standards. Seeking a Utilization Management role to support the appropriate level of care and healthcare resource utilization.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Home Health Case Manager
Team Select Home Care
Austin, TX
10.2024 - Current
- Managed a caseload of 25+ patients, evaluating care plans, and ensuring appropriate utilization of services based on patient needs.
- Coordinated interdisciplinary care for medically complex patients.
- Utilize the company's predictive hospitalization tool to ensure better client outcomes and prevent hospitalizations.
- Reviewed and maintained insurance authorizations, ensuring alignment with medical necessity, and payer requirements.
- Mentored three case managers on Medicaid regulations and agency documentation standards.
Director of Nursing
Pediatric Home Healthcare
03.2024 - 10.2024
- Oversaw clinical operations for the pediatric home health population, ensuring compliance with Medicaid and regulatory standards.
- Conducted retrospective chart reviews to ensure documentation met payer and regulatory requirements.
Case Manager
Pediatric Home Healthcare
05.2023 - 03.2024
- Evaluated and reassessed the medical necessity of services based on patient condition and payer guidelines.
- Completed admissions, recertifications, and discharges ensuring compliance with regulatory standards.
Pediatric Home Health Nurse
Pediatric Home Healthcare
02.2023 - 05.2023
- Provided 1:1 care to complex pediatric population, monitored patient conditions, reporting changes to case manager and patient physicians.
- Documented in EMR according to agency and Medicaid standards.
Registered Nurse, Pediatric Oncology
Dell Children's Medical Center
06.2022 - 02.2023
- Administered chemotherapy per protocol, and monitored patient outcomes.
- Collaborated with interdisciplinary teams to support individualized care planning.
Pediatric Registered Nurse
Lake Charles Memorial Health System
07.2021 - 06.2022
- Performed clinical assessments and documented findings in EMR.
- Communicated patient status changes to providers.
Education
Bachelor of Science - Nursing
McNeese State University
Lake Charles, LA05-2021
Skills
- Client advocacy
- Case management
- Teamwork and collaboration
- Regulatory compliance
- Clinical documentation review
- Interdisciplinary collaboration
Certification
- TX Nursing License #1143389
Timeline
Home Health Case Manager
Team Select Home Care
10.2024 - Current
Director of Nursing
Pediatric Home Healthcare
03.2024 - 10.2024
Case Manager
Pediatric Home Healthcare
05.2023 - 03.2024
Pediatric Home Health Nurse
Pediatric Home Healthcare
02.2023 - 05.2023
Registered Nurse, Pediatric Oncology
Dell Children's Medical Center
06.2022 - 02.2023
Pediatric Registered Nurse
Lake Charles Memorial Health System
07.2021 - 06.2022
Bachelor of Science - Nursing
McNeese State University