Kelly Nious
Austin,TX
Summary
Working with diverse populations often presents complex situations, so the ability to stay composed and find creative solutions is imperative. Showing cultural competency and having a non-judgmental approach fosters trust and rapport with individuals from all walks of life is also very important.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Program Specialist V
HHSC IDD Utilization Review
Austin, Texas
12.2023 - Current
- Conduct routine reviews and analyze Intellectual Disability/Related Condition (ID/RC) data to assess the need for additional oversight
- Conduct desk reviews to determine compliance with HHSC rules, policies and procedures related to enrollments, IPCs and LOC/LONs
- Conduct utilization reviews and evaluation of proposed IPCs and make clinical authorization decisions regarding participant eligibility and plans of care
- Evaluate IPC and eligibility activities and trends to resolve technical problems, identify opportunities for improvement and to make recommendations for improvements in utilization review processes
- Conduct analysis of data and reports as assigned, and collects, organizes, analyzes, and prepares materials in response to requests for program information, or special project reports
- Develop and revise utilization review tools (e.g., review protocols, evaluation forms, etc.) in accordance with program objectives and goals
- Serve as the lead to prioritize the work of colleagues by assigning provider deliverables to designated unit staff in absence of the unit supervisor
- Serve as an agency representative in Medicaid fair hearings
- Conduct training and provide guidance to staff in the development integration of new or revised operational procedures
- Coordinate the review and evaluation of information on service delivery system methods, outputs, and activities to identify gaps in resources and recommend improvements
- Coordinate and collaborate with program staff through participation in unit and cross-agency workgroups related to unit functions and planning to analyze, develop, and implement program initiatives
- Work under limited supervision with considerable latitude for the use of initiative and independent judgment.
Children’s Home Initiative (CHI) Case Manager
Foundation Communities
Austin, Texas
12.2022 - 12.2023
- Met regularly with individuals and identified areas of need, employed 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 client screenings and psychosocial and environmental assessment of residents to determine resources and services required
- Utilized biopsychosocial evaluations, trauma screenings, assessments, psychiatric evaluations, and risk assessments
- Provided therapeutic services to residents experiencing high levels of stress, trauma, or other psychological and mental issues
- Conducted individual and group counseling related to mental and behavioral problems (including substance-use)
- Developed, reviewed, and updated service and intervention plans with clients
- Prepared progress reports of client treatment and maintain documentation in accordance with professional standards in a timely manner, with a multidisciplinary team to collaborate and provide support for residents and meet ongoing needs through existing Foundation Communities programs and community resources
- Planned, developed, and conducted training sessions for staff and volunteers
- Provided mental health consultation and guidance to property staff, in matters of de-escalation, healthy boundaries, and trauma responsive care
- Adhered to agency Policies and Procedures, including billing and best-practice therapeutic services.
Ombudsman III
State Office of the Ombudsman
Austin, Texas
01.2019 - 12.2022
- Performed complex (journey-level) mediation work
- Work involved performing dispute resolution activities; assisted employees and the general 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
- Worked under general supervision, with moderate latitude for the use of initiative and independent judgment
- 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, and other stakeholders
- Advocated for the rights of 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, responded to requests for court action and resolving disability determination disputes.
Home Community Based Service Enrollment Coordinator (HCS)/ Intake Service Coordinator
Integral Care
Austin, Texas
01.2016 - 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 clients and/or their families to assess their psychosocial and/or resource needs
- Consult with 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
- 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
- Prepared a written Community First Choice (CFC) Assessment for consumers that need attendant services for activities of daily living and transportation; in which hours are reflected to determine the amount of time an attendant is required to be present in the home or community
- Completed IDD Intake appointments, in which a licensed psychologist administers psychological evaluations (Determination of Intellectual Disability/ICAP) to determine a diagnosis of IDD and/autism for adult and children’s cases to determine eligibility for services
- Evaluated and research individuals’ physical and mental impairments with related conditions; in which, a written referral was submitted for a HCS PASRR Diversion slot; to obtain services that assist with activities of daily living, vocational/employment opportunities, specialized therapies, nursing, and other services to sustain a better quality of life
- Completed/ submitted Medicaid applications for consumers to potentially access an opportunity of services and benefits available.
Support Specialist II
Department of Public Safety
Austin, Texas
03.2014 - 08.2016
- Assisted in program training and development for the Parent Taught Driver Education Process
- Scanned applications, coordinated orientations, and interviewed clients
- Verified DE-964 applications for Parent driver education and parents who were deployed
- Mailed out PTDE and DWLI packets and input information into Quick Key Application
- Verified payments and troubleshooted for technical errors
- Administered quality assurance with commercial driver license documents for individuals eligible to obtain CDL
- Reviewed and evaluated confidential cases announced by law enforcement agencies throughout the State of Texas
- Interacted with individuals who received tickets for invalid driver’s due to driving while intoxicated or were previously incarcerated for a DWI
- Implemented conflict resolution skills with independent judgment after analyzing an issue with clients
- Prepared subpoenas for private, district, and state attorneys
- Trained staff, coordinated, and facilitated weekly staff meetings
- Responded to phone and email messages in a timely manner.
Permanent Substitute Teacher
AISD
Austin, Texas
11.2011 - 03.2014
- Assumed the role and responsibilities for teachers who were on leave; for grades kindergarten- twelfth grade
- Implemented lesson curriculum as planned
- Created a safe and cohesive environment; through participation and sharing personal experiences
- Exercised active listening and independent judgement while facilitating enrichment activities.
Adjudicator of Claims, Social Worker (Disability Examiner III)
Department of Rehabilitation Services (DARS)
Austin, Texas
07.2006 - 10.2011
- Performed 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).
Education
Psychology And Counseling Program -
Walden University
12-2024
BACHELOR OF SCIENCE IN CRIMINAL JUSTICE -
Sam Houston State University
Skills
- Experience using Microsoft Word, PowerPoint, & Excel Spreadsheet
- Effective written and verbal communication
- Patient and flexible under pressure with a professional attitude
- Advance knowledge of Mental and Intellectual Disabilities
- Solid foundation in policy and procedures
- Maintains confidentiality for all reports and consumer personal information
- Strong ability to multi-task with challenges and responsibilities
Certification
- I am a passionate real estate agent with 3 years in the business and experience in residential real estate, with specialty certification in consulting for residential properties.
Timeline
Program Specialist V
HHSC IDD Utilization Review
12.2023 - Current
Children’s Home Initiative (CHI) Case Manager
Foundation Communities
12.2022 - 12.2023
Ombudsman III
State Office of the Ombudsman
01.2019 - 12.2022
Home Community Based Service Enrollment Coordinator (HCS)/ Intake Service Coordinator
Integral Care
01.2016 - 12.2018
Support Specialist II
Department of Public Safety
03.2014 - 08.2016
Permanent Substitute Teacher
AISD
11.2011 - 03.2014
Adjudicator of Claims, Social Worker (Disability Examiner III)
Department of Rehabilitation Services (DARS)
07.2006 - 10.2011
Psychology And Counseling Program -
Walden University
BACHELOR OF SCIENCE IN CRIMINAL JUSTICE -
Sam Houston State University
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