Holly Hensley
Roosevelt,WA
Summary
Proven leader in healthcare management, excelling in staff development and clinical quality improvement at Pacific Source Health Plans. Demonstrates exceptional organizational skills and a commitment to patient safety, leading to enhanced patient care and team efficiency. Skilled in regulatory compliance and insurance billing, with a knack for fostering teamwork and collaboration.
Respectful Clinical Manager with extensive knowledge of health care administration and clinical philosophy. Familiar with fiscal management systems and human resource management. Talented at maintaining and developing effective relationships with staff, patients and senior management. Excellent supervisory skills and performance working under pressure. Results-driven healthcare leader offering number of years of clinical, administrative and patient care experience. Gifted in building and implementing approaches to increase quality and streamline procedures. Significant leadership background directing multidisciplinary healthcare teams to achieve care objectives and outperform business targets.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Underwriting Clinical Manager
Pacific Source Health Plans
06.2018 - Current
- Reviewed referral information and kept track of intakes from various referral sources.
- Collected, evaluated, and modeled collected data.
- Reviews, renews, and analyzes applications for insurance coverage. Assisted by underwriting software and related computer programs, they assess the risk involved in insuring an individual or company, as well as determine the premiums for the expected coverage requested. A health insurance underwriter’s responsibilities include:
- Reviewing all new applications and inserting specific information (e.g., income, expenses, and health details) from those applications into underwriting software
- Assessing each applicant’s medical history and establishing if they have any preexisting conditions
- Analyzing the recommendations provided by the software for each application
- Deciding whether to approve applications
- If an application is approved, determining the extent of the coverage and calculating the premium based on the applicant’s risk assessment
- Consulting with the agents or insurance processors about the final decision
- To succeed through a combination of strong attention to detail, an understanding of company policy and industry standards, a tactful sense of organization, and a vested sense of why legal adherence is important for all involved parties, not just the company. Working on computers and using risk assessment software is also an integral part of the job, so insurance underwriters need a good command of technology.
- A liaisons between company agents, supervisors, and representatives. They outline why an application might not meet the recommended criteria for qualification, as well as how to potentially optimize applications for approval. This means they need strong written and verbal communication skills
Case Manager Team Lead
Pacific Source Health Plans
06.2018 - Current
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
- Enhanced communication between clients and providers through consistent follow-ups and progress updates.
- Achieved positive client outcomes by developing and implementing comprehensive case management plans.
- Advocated for client rights when interacting with external agencies or institutions, ensuring fair treatment at all times.
- Provided crisis intervention support for clients experiencing emergencies, using appropriate techniques to de-escalate situations safely.
- Contributed to team discussions and case conferences actively, sharing insights and expertise with colleagues to optimize client support strategies.
- Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
- Developed and implemented comprehensive case management plans to address client needs and goals.
- Improved client satisfaction by efficiently addressing concerns or grievances in a timely manner.
- Assisted clients in navigating housing, legal services and public benefits to gain access to valuable resources.
- Collaborated with multidisciplinary teams to address client needs and formulate tailored support strategies.
- Fostered open lines of communication with clients'' families and support networks, involving them in the case management process as appropriate.
- Participated in regular professional development opportunities to stay current on best practices within the field of case management.
- Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
Charge Nurse Manager
Prosser Memorial Hospital
10.2014 - 06.2018
- Collaborated with interdisciplinary teams to develop comprehensive care plans tailored to individual patient needs.
- Championed quality improvement initiatives within the unit, driving continuous enhancement of patient outcomes.
- Led multidisciplinary rounds involving physicians, pharmacists, therapists, dietitians, and nursing staff to ensure effective communication and coordination of patient care.
- Ensured compliance with state regulations and accreditation standards through regular audits and policy updates.
- Established clear communication channels between management and nurses, promoting transparency and open dialogue.
- Streamlined workflow for nursing staff, resulting in improved efficiency and patient satisfaction.
- Promoted a culture of teamwork by regularly acknowledging accomplishments of both individual nurses as well as collaborative achievements.
- Served as a liaison between administration and nursing staff regarding policy changes or concerns raised by either party.
- Coordinated discharge planning efforts with social workers, case managers, and other healthcare professionals to provide seamless transitions of care for patients.
- Managed patient census fluctuations by adjusting staffing levels accordingly, maintaining optimal nurse-to-patient ratios.
- Mentored new nurses to ensure smooth transition into the team, fostering a positive work environment.
- Managed staffing schedules, ensuring appropriate coverage and minimizing overtime costs.
- Supervised, directed, and motivated high-quality performance from nursing staff.
- Managed staff scheduling and time off to adequately staff nursing floors and allow nurses earned time off.
- Investigated and independently resolved complaints from staff, physicians, and patients by leveraging clinical judgment and unit management expertise.
Education
Associate of Science - Pediatric Nursing
Seattle Central Community College
Seattle, WA06.1994
Associate of Science - Nursing
Boise State University
Boise, ID05.1993
High School Diploma -
Meridian High School
Meridian, ID06.1989
Skills
- Clinical Leadership
- Training and mentoring
- Staff Supervision
- Staff Scheduling
- Staff Development
- Managerial experience
- Team Management
- Patient Flow
- Supervisory Experience
- Insurance Billing
- Patient Relations
- Medical practice management
- Clinical Quality Improvement
- Direct Patient Care
- Quality Control
- Quality Improvement
- Onboarding and coaching
- Emergency situational awareness
- Patient Safety
- Patient Engagement
- Patient Care
- Team Meetings
- Activity Coordination
- Case Management
- Utilization review
- Reimbursement tracking
- Insurance Verification
- Claims Handling
Certification
CLNC
CCM
OR RN Lic
ID RN Lic
WA RN Lic
Timeline
Underwriting Clinical Manager
Pacific Source Health Plans
06.2018 - Current
Case Manager Team Lead
Pacific Source Health Plans
06.2018 - Current
Charge Nurse Manager
Prosser Memorial Hospital
10.2014 - 06.2018
Associate of Science - Pediatric Nursing
Seattle Central Community College
Associate of Science - Nursing
Boise State University
High School Diploma -
Meridian High School
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