Holly Shepler
Moyock,NC
Summary
Experienced disability clinician with strong business and contract background.
Overview
20
20
years of professional experience
Work History
Senior Clinical Consultant
Unum
04.2023 - Current
- Perform clinical reviews and participate in Forum discussions in both AMC and Total Leave
- Participate in multiple special projects to include providing onboarding training and mentoring to newly hired Clinical Consultants, participated in the ODG pilot, collaborated with peers to develop and provide pre-ex training, develop Fineos training materials for the clinical teams and support peers as they transition from NaviLink to Fineos
- Maintain excellent QA scores while completing project work.
Clinical Consultant
Unum
09.2021 - 04.2023
- Perform clinical reviews and participate in Forum discussions for aligned Business Units
- Completed Mentor Certification
- Completed the Career Launch series
- Mentored a new hire Clinical Consultant and a Benefit Specialist.
Quality Review Nurse
Professional Disability Associates (Now Brown & Brown)
08.2019 - 09.2021
- Responsible for quality review and finalization of Peer Review reports for a network of roughly 250 physicians throughout all specialties of the medical field to include behavioral health specialties
- Onboard, train and mentor physicians and nurses new to consulting
- Project lead for specialized services for multiple customers to include Cigna, Prudential, Anthem and Guardian.
Clinical Consultant LTD
The Hartford
01.2018 - 07.2019
- Responsible for assessment of medical records to determine functional capacity and provide claim management direction
- Frequent communication with physicians to clarify functional capacity when exams and diagnostic findings do not correlate with the prescribed restrictions
- Participate in weekly test change triage meetings and strategic claim discussions
- Go to resource for pre-existing reviews with ‘caused or contributed to’ plan language
- Work closely with the appeals unit to complete reinstatement triage meetings and reinstatement reviews
- Excellent performance ratings, 5/5.
Clinical Consultant LTD
Aetna
06.2015 - 01.2018
- Responsible for assessment of medical records to determine functional capacity and provide claim management direction
- Frequently contacted physicians to clarify functional capacity when exams and diagnostic findings do not correlate with the prescribed restrictions
- Participate in weekly test change triage meetings and strategic claim discussions
- Proficient in pre-existing reviews with ‘caused or contributed to’ plan language
- Work closely with the appeals unit to complete reinstatement triage meetings and reinstatement reviews
- Recognized as a high performer with productivity and audit results far exceeding required metrics
- Identified by external audit as providing best in class clinical assessments and claim direction
- C.A.R.E Award winner
- Excellent performance ratings 5/5.
Short Term Disability Nurse Case Manager
Aetna
05.2007 - 05.2015
- Responsible for assessment of clinical data and plan contracts to determine functional capacity and eligibility for disability benefits
- Maintained a caseload of active claims as a case manager with focus on return to work potential for a diverse population with wide ranging PDLs (physical demand levels) and SVPs (specific vocational preparation)
- Worked closely with the vocational rehabilitation counselor to develop return to work plans and establish work place accommodations
- Provided oral and written communication of adverse claim decisions to claimants
- Participated in complex claim round table discussions with a multi-disciplinary team to formulate claim management plans
- Worked as a trainer and mentor for both clinicians and analysts
- Multiple awards for collaboration, quality of work and leadership
- Excellent performance ratings 5/5.
Hospice Case Manager
3HC Home Health and Hospice Care
12.2005 - 04.2007
- Responsible for hospice care over four counties and ongoing home health visits in my local county
- Collaborated closely with physicians, patients and their families to provide end of life care and planning
- Offered a marketing position just prior to leaving the company for an out of state relocation.
Home Health RN
10.2005 - 12.2005
- Responsible for home visits to deliver wound care, infusion therapy, ostomy care, venipuncture, PICC / central line care and dressing changes, management of ambulatory chemotherapy pumps and infusions and post-op care
- Responsible for supervision of LVNs and home health aides, disease management teaching, medication management and completing appropriate certifications, documentation and physician communications.
Medical-Surgical Unit Staff Nurse and Preceptor
North Austin Medical Center
11.2004 - 07.2005
- After working for just 6 months as a new nurse, selected by leadership to serve as a preceptor for new hires
- I also assisted the clinical education department with training.
Medical-Surgical Unit Staff Nurse
05.2004 - 11.2004
- Responsible for delivery of care to a wide variety of medical and post-op patients.
Education
Bachelor of Science, Business Management -
University of Phoenix
Associate Degree of Nursing -
Austin Community College
Skills
Assessment of functional capacity
Complex claim reviews
Contracts
Training
Mentoring
Quality
Timeline
Senior Clinical Consultant
Unum
04.2023 - Current
Clinical Consultant
Unum
09.2021 - 04.2023
Quality Review Nurse
Professional Disability Associates (Now Brown & Brown)
08.2019 - 09.2021
Clinical Consultant LTD
The Hartford
01.2018 - 07.2019
Clinical Consultant LTD
Aetna
06.2015 - 01.2018
Short Term Disability Nurse Case Manager
Aetna
05.2007 - 05.2015
Hospice Case Manager
3HC Home Health and Hospice Care
12.2005 - 04.2007
Home Health RN
10.2005 - 12.2005
Medical-Surgical Unit Staff Nurse and Preceptor
North Austin Medical Center
11.2004 - 07.2005
Medical-Surgical Unit Staff Nurse
05.2004 - 11.2004
Bachelor of Science, Business Management -
University of Phoenix
Associate Degree of Nursing -
Austin Community College
Similar Profiles
Josalyn KellyJosalyn Kelly
Learning Consultant at UnumLearning Consultant at Unum
Michael FlibbertMichael Flibbert
National Relationship Director at UnumNational Relationship Director at Unum
Amanda SchmechelAmanda Schmechel
Life Benefits Specialist at UNUMLife Benefits Specialist at UNUM
Bryce TallantBryce Tallant
Quote Specialist at UnumQuote Specialist at Unum
Madison CartwrightMadison Cartwright
Food and Beverage Attendant at H2OBX WaterparkFood and Beverage Attendant at H2OBX Waterpark