Holly Reed RN, BSN
10439 Antietam Ridger, Independence,KY
Summary
Professional Nurse Manager with a strong background in Utilization Management and Nursing Leadership, dedicated to optimizing staff scheduling and fostering effective team leadership. Expertise in healthcare compliance ensures adherence to industry standards while enhancing operational efficiency. A proven track record of improving interdepartmental communication drives quality improvement initiatives and elevates performance across healthcare settings. Committed to delivering exceptional patient care through strategic management and collaborative teamwork.
Overview
16
16
years of professional experience
Work History
UM Nurse Manager
Humana
07.2018 - Current
- Delivered innovative solutions enhancing team performance and achievements.
- Developed efficient scheduling systems optimizing resource allocation.
- Coordinated interdepartmental communication improving workflow efficiency.
- Facilitated training sessions for new team members on internal processes.
- Completed monthly associate 1:1s, as well as mid-year and end-of-year reviews.
- Bi-Weekly team meetings, with focus on team education and updates
- Created reports summarizing departmental activities and progress updates.
- Implemented feedback systems, boosting associate interactions and satisfaction.
- Maintained documentation of policies and procedures for reference purposes.
- Evaluated nurses' reviews for operational effectiveness and compliance guidelines.
- Reviewed documentation to ensure it is accurate and up to date, according to established guidelines.
- Utilized critical thinking skills to assess clinical reviews quickly and accurately.
- Managed multiple tasks simultaneously while prioritizing urgent requests from physicians or nurses.
- Participated in quality improvement initiatives in order to improve patient outcomes.
QIO Team Lead
Humana
08.2016 - 07.2018
- Optimized team productivity by delegating daily tasks to members effectively.
- Implemented process improvements that enhanced overall team efficiency.
- Mentored junior team members, fostering skill development and professional growth.
- Developed comprehensive training materials for new employee onboarding.
- Analyzed performance metrics to pinpoint areas needing improvement.
- Trained new staff on relevant procedures and processes to ensure competency.
- Motivated team through positive reinforcement techniques to boost morale.
- Oversaw daily operations and workflow, ensuring accurate completion of duties.
UM Nurse 2 - Nurse Reviewer
Humana
03.2010 - 08.2015
- Coordinated communication between insurance companies and healthcare facilities.
- Adhered strictly to HIPAA regulations pertaining to confidentiality of patient information.
- Prepared detailed reports summarizing findings from various claim reviews conducted.
- Performed pre-certification reviews to determine coverage eligibility for services.
- Conducted post payment reviews to ensure compliance with insurance guidelines.
- Interpreted health plan policies, benefit plans, and other regulations related to claim processing.
- Participated in provider education sessions regarding proper coding and billing procedures.
- Provided guidance on utilization review decisions when requested by providers.
- Precepted new nurses and staff and provided continuous hands-on development opportunities.
Education
Bachelor of Science - Nursing Science
Western Governors University
Salt Lake City, UT07-2020
Associate of Science - Nursing Science
Spencerian College
Louisville, KY05-2012
Licensed Practical Nurse - LPN
William Booth School of Nursing
Florence09-1988
Skills
- Staff scheduling and assignments
- Healthcare compliance
- Quality improvement and performance
- Customer relationship management
- Operational oversight
- Employee training and development
- Team building and leadership
- Effective communication skills
- Interdepartmental coordination
- Problem solving and critical thinking
- Electronic charting expertise
- Clinical supervision and management
- Motivational skills and coaching
- Workload management and prioritization
- Ethical practice in healthcare
- Conflict management strategies
- Utilization management techniques
- Case review and management
- Staff supervision
- Critical thinking
- Quality improvement
- Department management
- Policy development
- Staff leadership
- Conflict management
- Performance improvement
- Staff coaching and mentoring
- Emergency response
- Budget management
- Budget planning
- Strong clinical judgment
- Utilization management
- Task delegation
- Workload management
- Motivational skills
Accomplishments
- Silver Star Award - exceptional dedication and commitment, encouragement of growth & education of my associates
- Bronze Star Award - exceptional dedication and commitment and leading with positivity
- Helping Hands award - Volunteering and managing team during a high volume time, to help another region overcome deficits and keeping cases within compliance time frames
References
References available upon request.
Timeline
UM Nurse Manager
Humana
07.2018 - Current
QIO Team Lead
Humana
08.2016 - 07.2018
UM Nurse 2 - Nurse Reviewer
Humana
03.2010 - 08.2015
Associate of Science - Nursing Science
Spencerian College
Licensed Practical Nurse - LPN
William Booth School of Nursing
Bachelor of Science - Nursing Science
Western Governors University