Summary
Overview
Work History
Education
Skills
Timeline
Generic

KELLY HOLLIDAY

Summary

Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.

Overview

24
24
years of professional experience

Work History

Grievance Nurse

Inland Empire Health Plan
12.2022 - Current
  • Clinical review of our in-patient members tor out of area/out of network facilities
  • Work closely with Case Managers from our contracted/non contracted facilities to manage discharge needs
  • Ensure the orders are followed through and refer our members appropriately to our resources within IEHP
  • Process authorizations for HLOC, LLOC based on clinical criteria.
  • Performed accurate documentation of patient assessments, interventions, and outcomes in compliance with regulatory standards.
  • Promoted a safe and comfortable healing environment by addressing patient concerns promptly and professionally.
  • Collaborated with interdisciplinary teams for optimized patient treatment plans and outcomes.
  • Mentored new nursing staff members, fostering teamwork and improving unit efficiency.
  • Reported findings to quality departments after conducting routine restraint audits and worked with team to devise corrective actions for deficiencies.
  • Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
  • Collaborated with leadership to devise initiatives for improving nursing satisfaction, retention and morale.

Concurrent Review Nurse

Inland Empire Health Plan
03.2020 - 12.2022
  • Clinical review of our in-patient members tor out of area/out of network facilities
  • Work closely with Case Managers from our contracted/non contracted facilities to manage discharge needs
  • Ensure the orders are followed through and refer our members appropriately to our resources within IEHP
  • Process authorizations for HLOC, LLOC based on clinical criteria.
  • Elevated patient satisfaction scores through proactive communication and addressing concerns promptly.
  • Contributed to the development of evidence-based policies and procedures for the case management department, ensuring alignment with industry best practices and regulatory requirements.
  • Identified opportunities for improvement within the case management department, contributing to overall operational efficiency gains.
  • Optimized resource utilization by assessing the appropriateness of medical treatments and making recommendations for alternative courses of action when necessary.
  • Served as a liaison between healthcare providers, insurers, patients, and families to facilitate communication and resolve issues related to care coordination or coverage determinations.
  • Promoted a culture of continuous learning by staying current on industry best practices and sharing knowledge with colleagues.
  • Reduced hospital readmission rates with timely assessments and effective discharge planning.
  • Managed complex cases effectively, coordinating with multidisciplinary teams to ensure seamless delivery of care across the continuum.
  • Supported effective care transitions by collaborating with healthcare providers, patients, and families to develop individualized discharge plans.
  • Streamlined the utilization review process for more efficient case management and improved resource allocation.
  • Developed strong rapport with patients and families by demonstrating empathy, active listening skills, and a genuine commitment to their wellbeing.
  • Provided ongoing education to nursing staff regarding best practices in concurrent review processes, enhancing overall team performance.
  • Expedited patient throughput within the hospital setting by identifying barriers to timely discharges or transfers and working collaboratively with stakeholders to address them.
  • Achieved timely authorizations for services by maintaining strong relationships with insurance company representatives and advocating for patients'' needs.
  • Evaluated patient histories, complaints, and current symptoms.
  • Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.

Nurse- COVID Unit

Arrowhead Regional Medial Center
11.2020 - 01.2021
  • Improved patient outcomes by administering medications, monitoring vital signs, and documenting relevant information.
  • Cared for wounds, provided treatments, and assisted with procedures.
  • Assisted with admissions, appointments, transfers, and discharges.
  • Collaborated with interdisciplinary healthcare teams to ensure continuous quality improvement in patient care delivery.
  • Facilitated efficient communication between patients, families, and healthcare providers to promote continuity of care across settings.
  • Managed time-sensitive tasks effectively under pressure while maintaining composure during critical situations or emergencies.
  • Obtained patient vital signs and input/output measurements from inpatients.
  • Adapted quickly to changing patient needs, adjusting care plans accordingly to ensure optimal outcomes in diverse clinical scenarios.
  • Gathered lab specimens, ordered testing, and interpreted results to diagnose patients.
  • Delivered updates in patient status to charge nurse, recording changes in medical records.
  • Offered immediate assistance in emergency and routine paging situations to evaluate needs and deliver care.
  • Used aseptic techniques to provide sterilized wound care and dressing applications.
  • Maintained a safe and therapeutic environment for patients through effective risk assessment and crisis intervention strategies.

Utilization Management /Customer Care Manager

St Mary's High Desert Medical Group
01.2013 - 11.2020
  • Managed 120 members with their complex needs
  • Implemented effective quality control measures to minimize errors and ensure high standards of service.
  • Handled complaints, provided appropriate solutions, and alternatives within appropriate timeframes and followed up to achieve resolution.
  • Facilitated open communication between team members, promoting a supportive work environment that encouraged collaboration and innovation.
  • Scheduled and attended meetings with clients and prospective clients as requested.
  • Conducted regular performance evaluations for continuous improvement and employee growth opportunities.
  • Played a crucial role in meeting or exceeding departmental KPIs consistently through strong leadership skills combined with strategic planning.
  • Managed escalations effectively, ensuring prompt resolution of issues and maintaining customer confidence.
  • Organized daily workflow and assessed appropriate staffing to provide optimal service.
  • Supervised daily operations and sales functions to maximize revenue, customer satisfaction, and employee productivity.
  • Mentored new hires, fostering growth and professional development within the team.
  • Built client relationships by responding to inquiries, identifying and assessing clients' needs, resolving problems, and following up with potential and existing clients.
  • Collaborated with cross-functional teams to address customer concerns, resulting in a holistic approach to problemsolving.
  • Adapted quickly to changing business needs by revising processes for increased flexibility and scalability in service delivery.
  • Oversaw daily operations of the customer care team, allocating resources efficiently to meet business goals.
  • Delegated tasks to existing support team members and used cloud-based tools to help solve complex business issues.
  • Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing, and other enabling services for patients.
  • Worked with providers to define quality metrics and outcome reporting process.
  • Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
  • Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.

Utilization Management Coordinator

Desert Valley Medical Group
01.2012 - 12.2012
  • Increased staff productivity by providing ongoing training and support on utilization management policies and procedures.
  • Collaborated closely with physicians to identify appropriate levels of care based on medical necessity criteria during admissions process.
  • Managed complex cases effectively, working closely with interdisciplinary teams to develop comprehensive care plans tailored to individual needs.
  • Maintained accurate documentation of all reviews, appeals, and decisions in line with organizational standards and requirements.
  • Served as a liaison between patients, families, caregivers, providers, payers, and community resources to ensure seamless transitions throughout the continuum of care.
  • Ensured regulatory compliance by staying updated on industry guidelines and applying them to daily tasks and assessments.
  • Contributed to the development of departmental goals, objectives, and performance improvement initiatives for continuous enhancement of services provided.
  • Actively participated in interdisciplinary team meetings to provide input on patient care, discharge planning, and resource utilization.
  • Streamlined communication process between nursing staff and case managers, reducing any delays in patient care plans.
  • Enhanced patient care by efficiently coordinating utilization management processes and reviewing medical records for case appropriateness.
  • Assisted in the development of policies and procedures, ensuring compliance with state regulations and accreditation standards for utilization management practices.
  • Conducted proactive patient evaluations to anticipate potential barriers in their treatment plan or discharge process.
  • Reduced hospital readmission rates through thorough assessment of patient needs, developing appropriate post-discharge plans.

Quality Health Safety and Environmental Manager

Mars Petcare
01.2000 - 11.2010
  • Delivered timely reports on key performance indicators to senior leadership, driving informed decision-making on resource allocation toward HSE priorities.
  • Improved environmental compliance by conducting thorough audits and implementing corrective actions.
  • Maintained industry certifications such as ISO 9001 or OHSAS 18001 by consistently meeting audit requirements and demonstrating ongoing commitment to excellence in QHSE management systems.
  • Managed budgetary responsibilities for department expenditures while ensuring optimal resource utilization for maximum return on investment in safety initiatives.
  • Championed a culture of safety throughout the organization through consistent communication, education, and reinforcement of best practices.
  • Led cross-functional teams in the execution of continuous improvement initiatives for process optimization and waste reduction.
  • Developed and maintained a robust HSE management system, ensuring adherence to industry standards and regulations.
  • Strengthened company reputation by proactively addressing customer concerns related to product quality, safety, and environmental impact.
  • Introduced innovative safety technologies that minimized hazards while optimizing operational efficiency.
  • Conducted internal and external audits, identifying gaps in processes and implementing measures to drive accountability for HSE compliance.
  • Developed and executed comprehensive emergency response plans, equipping employees with critical knowledge and tools to effectively manage crisis situations.
  • Promoted employee wellness initiatives, contributing to a healthier workforce and lower absenteeism rates.
  • Reduced workplace accidents through comprehensive safety training programs and proactive hazard identification.
  • Oversaw incident investigations, root cause analysis, and corrective action implementation to prevent recurrence of issues.
  • Prepared detailed scientific reports or presentations based on findings.
  • Assisted with development of health and safety plans for hazardous materials.
  • Performed environmental site assessments and provided remediation recommendations.
  • Investigated accidents and analyzed root causes to develop corrective action plans.
  • Served as technical consultant on environmental policies to maintain regulatory compliance.
  • Conducted air quality monitoring and analysis of air pollutants.
  • Formulated and implemented long-range plans for environmental programs.
  • Managed development, design and execution of energy conservation projects.

Education

Summit Career College

Bachelor of Arts - Organizational Leadership

Claremont Lincoln University
Grand Terrace, CA
08.2025

Associates Math & Science -

Victor Valley Community College
08.2021

Skills

  • Proficiency in Microsoft Office, PowerPoint, Excel, Project
  • All scripts, Touchworks, Care Director, Access, Medhok/UM/Grievances, DB Motion, IPA Portals for Authorizations
  • Working knowledge of managed care including HEDIS and CAHPs, CMS, DMHC and NCQA regulations health plan regulations
  • Direct Patient Care
  • Medication and IV administration
  • Patient Care
  • Clinical judgment
  • Wound Management
  • Diabetes management
  • Disease Prevention

Timeline

Grievance Nurse

Inland Empire Health Plan
12.2022 - Current

Nurse- COVID Unit

Arrowhead Regional Medial Center
11.2020 - 01.2021

Concurrent Review Nurse

Inland Empire Health Plan
03.2020 - 12.2022

Utilization Management /Customer Care Manager

St Mary's High Desert Medical Group
01.2013 - 11.2020

Utilization Management Coordinator

Desert Valley Medical Group
01.2012 - 12.2012

Quality Health Safety and Environmental Manager

Mars Petcare
01.2000 - 11.2010

Summit Career College

Bachelor of Arts - Organizational Leadership

Claremont Lincoln University

Associates Math & Science -

Victor Valley Community College

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KELLY HOLLIDAY