Work Preference
Summary
Overview
Work History
Education
Skills
Timeline
Generic
Open To Work

Kelly Nious

Work Preference

Job Search Status

Open to work
Desired start date: Open to discussion

Desired Job Title

Clinical Reviewer IVProgram Specialist VChildren's Home Initiative Case ManagerOmbudsman IIIHome Community Based Service Enrollment Coordinator (HCS)/ Intake Service Coordinator

Work Type

Full TimeConsulting

Location Preference

RemoteHybrid
Location: Austin, TX
Open to relocation: No

Salary Range

$68000/yr - $200000/yr

Important To Me

Work-life balanceFlexible work hoursWork from home optionHealthcare benefitsPaid sick leavePersonal development programsPaid time off4-day work weekCareer advancement

Summary

Compassionate and dedicated professional with over 20 years of experience in providing evidence-based interventions and therapeutic techniques, adept at navigating complex situations involving diverse populations. Strong ability to remain composed under pressure and develop creative solutions that foster trust and rapport with individuals from all walks of life. Cultural competency and a non-judgmental approach are integral to building effective relationships, ensuring that client needs are met with sensitivity and respect. Expertise in crisis intervention and contract compliance, along with a thorough understanding of the contract management lifecycle, enhances the capacity to effectively address varied client requirements.

Overview

20
20
years of professional experience

Work History

Clinical Reviewer IV

Health and Human Services Commission IDD Utilization Review
Austin, Texas
03.2025 - Current
  • Review and analyze Intellectual Disabilities/Related Conditions; Conduct medical reviews to evaluate IPC to authorize clinical decisions to determine eligibility and plan of care. Analyzed over 50 data and reports.
  • Performed and revise utilization review tools in accordance with program objectives and goals. Serve as the lead to prioritizing work by assigning workloads to unit staff; Agency representative in fair hearings. Negotiate with vendors; train staff as needed

Program Specialist V

Health and Human Services Commission /HCBS-AMH-Behavioral Health
Austin Texas
09.2023 - 03.2025
  • Documented, reviewed, and reported over 75 serious incidents involving clients in state-operated facilities, state hospitals and community-based programs.
  • Duties included incident documentation and reporting; Investigation and evidence collection; Regulatory Compliance; Risk management, and collaborating with external and internal stakeholders, law enforcement, and medical professionals to gather information.

Children's Home Initiative Case Manager

Foundation Communities
Austin, Texas
02.2020 - 09.2023
  • Met regularly with individuals and identify areas of need, employ crisis intervention and de-escalation strategies, and evaluated progress toward improving personal health and stability.
  • Utilized knowledge of principles, methods, techniques, and evidence-based practices in counseling to support case management work.
  • Conducted over 40 client screenings and psychosocial and environmental assessment of residents to determine resources and services required.
  • Planned, developed, and conducted training sessions for staff and volunteers.
  • Provided individual and group counseling related to mental and behavioral problems including substance-use.

Ombudsman III

State Office of the Ombudsman Health and Human Services Commission
Austin, Texas
01.2019 - 12.2022
  • Performed complex senior level mediation work.
  • Work involved performing dispute resolution activities; assisted employees and the public in resolving conflicts and issues or concerns in situations such as filing claims, obtaining, or disputing benefits, or resolving grievances.
  • Prepared participants for conferences, meetings, hearings, and proceedings; and investigating complaints.
  • Prioritized and resolved issues and complaints by initiating investigations, conducting research, and explaining laws, policies, and procedures; made referrals and/or escalated more complex issues to higher-level employees within the department.
  • Advised on and explained relevant state and federal rules, regulations, programs, and procedures to employees, the public, internal and external stakeholders.
  • Advocated for the rights of over 300 residents in facilities.
  • Consulted with various groups on issues and procedures concerning conferences, meetings, hearings, and arbitration proceedings.
  • Assisted employees or the public in applying for benefits, preparing for hearings, and responding to requests for court action, and resolving disability determination disputes.

Home Community Based Service Enrollment Coordinator (HCS)/ Intake Service Coordinator

Integral Care Travis County MHMR
Austin, Texas
01.2014 - 12.2018
  • Completed enrollments for children and adults from the Texas Home Living Program who were eligible to receive services for the Home Community Based Program according to an intellectual developmental disability (IDD) diagnosis determined by a licensed psychologist.
  • Interview 100 clients weekly and/or their families to assess their psychosocial and/or resource needs.
  • Trained health care team to further their understanding of patient social and emotional factors.
  • Communicated and established professional relationships with consumers, guardians, attorney's, providers, organizational entities (CPS), and families by frequent contact via email, telephone calls, and face to face visits in the office/community (day habilitation, home, nursing facilities); as it relates to an individual's needs upholding complex case management until enrollment completion.
  • Worked with diverse populations and refugee social service programs.
  • Coordinated and facilitated enrollment meetings to identify needs to attain desired outcomes and services for individuals with a written Person Directed Plan to ensure that services would be monitored monthly so that the individual's needs were met.
  • Was liaison for linking consumers, guardians, families, and providers to appropriate community resources (medical, social, educational, financial) and supports that would help individuals maintain an optimal quality of life.

Adjudicator of Claims Disability Examiner III

Department of Rehabilitation Services (DARS) HHSC
Austin, Texas
07.2006 - 11.2013
  • Managed approximately 215 moderately complex case management services to individuals who alleged a mental or/and physical disability; that demonstrated an inability to work.
  • Adjudicated Social Security Administration (SSA) adult and childhood initial and reconsideration cases.
  • Assisted children, parents, and guardians with access linkage to medical, social, and financial services.
  • Attended Accelerated Rehabilitative Disposition meetings to assess client's needs and strengths to coordinate services.
  • Evaluated, planned, and implemented effective interventions and service plans.
  • Applied effective therapeutic communication skills (active listening, open-ended questions, non-judgmental, client-centered, empathy, conflict resolution, and de-escalation)
  • Applied laws and regulations to advise acceptance or rejection of claims.
  • Maintained detailed records of all case-related information within electronic databases.
  • Communicated decisions clearly and concisely to claimants, both verbally and in writing.
  • Gave medical opinion to the administrative law judge and attended formal hearings, issued subpoenas and administering oaths.
  • Worked closely with medical professionals to gather necessary documentation for disability claims reviews.

Education

Clinical Counseling - Clinical Counseling

Walden University
Minneapolis, MN
10-2026

Bachelor of Science - Criminal Justice and Psychology

Sam Houston State University
Huntsville, TX

Skills

  • Skilled in keeping up the contract management lifecycle
  • Contract Compliance
  • Monitor Budgets
  • Solid foundation in policy and procedures
  • Records management
  • Confidentiality practices
  • Strategic thinking
  • Negotiation
  • Clinical judgment
  • Medical coding
  • Troubleshooting abilities
  • ICD-10 coding
  • Electronic health records
  • Medical documentation
  • Excellent communication
  • HIPAA compliance

Timeline

Clinical Reviewer IV

Health and Human Services Commission IDD Utilization Review
03.2025 - Current

Program Specialist V

Health and Human Services Commission /HCBS-AMH-Behavioral Health
09.2023 - 03.2025

Children's Home Initiative Case Manager

Foundation Communities
02.2020 - 09.2023

Ombudsman III

State Office of the Ombudsman Health and Human Services Commission
01.2019 - 12.2022

Home Community Based Service Enrollment Coordinator (HCS)/ Intake Service Coordinator

Integral Care Travis County MHMR
01.2014 - 12.2018

Adjudicator of Claims Disability Examiner III

Department of Rehabilitation Services (DARS) HHSC
07.2006 - 11.2013

Clinical Counseling - Clinical Counseling

Walden University

Bachelor of Science - Criminal Justice and Psychology

Sam Houston State University

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Kelly Nious