Kelly Phillips
New Vienna,Ohio
Summary
Clinical professional with deep expertise in patient care management, clinical assessments, and healthcare consulting. Strong collaborator, known for flexibility and reliability in dynamic environments, consistently driving team success and patient outcomes. Proficient in treatment planning, regulatory compliance, and interdisciplinary communication, bringing results-focused approach to every task. Recognized for analytical thinking, problem-solving skills, and commitment to continuous improvement in patient care. Experienced with team leadership, strategic planning, and operational management. Utilizes effective communication and organizational skills to drive project success. Track record of fostering productive work environments and achieving set goals.
Overview
16
16
years of professional experience
Work History
Manager Utilization Management
Humana
07.2016 - Current
- Trend/analyze reports for productivity, quality and uncover areas of opportunity for overall organization success
- Provide and ensure exceptional customer service to members, providers, and ancillary customers/departments
- Mentored junior team members for career advancement, fostering a pipeline of future leaders within the organization.
- Effectively coordinate and supervise multiple workflows to ensure delivery exceptional member care in allocated areas of responsibility
- Defined clear targets and objectives and communicated to other team members.
- Enhanced team productivity by implementing effective scheduling strategies.
- Streamlined operations with innovative process improvements.
- Boosted employee engagement by leading motivational initiatives.
- Facilitated training sessions for team skill enhancement.
- Led diverse teams to achieve company objectives and enhance workplace culture.
- Improved team performance by conducting regular performance reviews.
- Spearheaded initiatives to enhance team communication and collaboration.
- Aligned team goals with company objectives to drive success.
- Directed recruitment efforts to build a high-performing team.
- Coordinated cross-departmental collaboration to improve project outcomes.
Clinical Advisor RN-Utilization Management
Humana
03.2016 - 07.2016
- Conducted case reviews to identify and address potential gaps in care delivery.
- Reduced hospital readmissions by developing comprehensive discharge plans and ensuring proper follow-up care.
- Managed network participation, care with specialty networks, care with DME providers and transfers to alternative levels of care using your knowledge of benefit plan design.
- Reviewed medical records diligently for accuracy and completeness while maintaining strict confidentiality standards at all times.
- Conducted comprehensive assessments to devise individualized treatment plans.
- Provided expert clinical guidance to improve patient care outcomes.
- Collaborated with multidisciplinary teams to enhance quality of care.
- Facilitated communication between healthcare providers for seamless patient transitions.
- Offered support and mentorship to junior staff to foster professional development.
Registered Nurse Care Manager
Humana
03.2014 - 03.2016
- Improved patient outcomes by developing and implementing comprehensive care plans tailored to individual needs.
- Mentored junior nursing staff, contributing to a supportive learning environment and fostering professional growth.
- Led multidisciplinary case conferences focused on optimizing patient outcomes through collaborative problem-solving approaches.
- Facilitated patient education on disease management, medication adherence, and lifestyle modifications to promote optimal health.
- Identified gaps in care for at-risk populations, leading to the development of targeted interventions to improve health outcomes.
- Conducted comprehensive assessments of patients'' physical, emotional, social, and environmental needs to inform personalized care plans.
- Served as a liaison between patients, healthcare providers, and insurance companies to ensure timely access to necessary services and resources.
Inpatient RN Case Manager/Utilization Review
Clinton Memorial Hospital
01.2012 - 03.2014
- Collaborated with interdisciplinary teams to optimize patient care and streamline processes.
- Act as a patient advocate in by providing patients/families with special needs with appropriate resources and referral.
- Educated physicians, patients, families, and staff regarding case management process and InterQual/MCG screening criteria.
- Monitored patient progress to adjust care plans and ensure effective treatment.
- Served as a resource and provides education to patients, physicians and professional staff on levels of care, quality of care issues and regulatory concerns.
- Advocated for patient needs, ensuring access to necessary resources and services.
- Provided patient education to enhance understanding of health conditions and treatment plans.
- Facilitated discharge planning for safe and effective transitions from hospital to home.
- Identified gaps in care delivery and proposed solutions to enhance service quality.
- Conducted case reviews to ensure compliance with healthcare standards and protocols.
- Managed complex caseloads, balancing multiple priorities to meet patient needs.
- Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
Nursing Supervisor
Clinton Memorial Hospital
01.2011 - 03.2014
- Promoted interdisciplinary collaboration by fostering strong relationships with physicians, therapists, and other healthcare professionals.
- Mentored new nursing staff members to promote adherence to established best practices and foster professional growth.
- Followed all HIPAA rules and regulations regarding patient confidentiality.
- Delegated tasks and provided leadership for 75-90 nurses and support personnel.
- Contributed to positive team dynamics as an approachable supervisor who actively listened to concerns from both patients and nurses.
- Streamlined workflow for nursing staff by conducting regular unit assessments and process improvements.
- Managed staffing needs efficiently by creating flexible schedules that maximized coverage during peak times without exceeding budget constraints.
- Provided direct nursing care to patients when personnel was short-staffed.
- Maintained proper staff levels within budget parameters to deliver high levels of care to every patient.
- Improved patient satisfaction scores by addressing concerns promptly and ensuring consistent delivery of high-quality care.
Registered Nurse Intensive Care/Charge RN
Clinton Memorial Hospital
01.2009 - 03.2014
- Oncology/Chemotherapy infusion nurse
- Coordinated patient care, ensuring timely and effective treatment plans.
- Managed patient records with meticulous attention to detail, ensuring data accuracy.
- Assisted physicians to facilitate efficient medical procedures.
- Mentored junior staff to foster a supportive and educational environment.
- Enhanced patient outcomes by collaborating with multidisciplinary teams.
- Conducted assessments for accurate diagnosis and treatment planning.
- Administered medications to support patient recovery and health maintenance.
- Supported critical care units with specialized nursing skills.
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
Education
Bachelor of Science - Nursing
Kaplan University
Davenport, IA02-2012
Associate of Science - Nursing
Southern State Community College
Hillsboro, OH06-2007
Skills
- Team leadership
- Project management
- Strategic planning
- Budget management
- Performance evaluation
- Conflict resolution
- Process improvement
- Decision making
- Time management
- KPI tracking
- Data analysis
- Employee engagement
Timeline
Manager Utilization Management
Humana
07.2016 - Current
Clinical Advisor RN-Utilization Management
Humana
03.2016 - 07.2016
Registered Nurse Care Manager
Humana
03.2014 - 03.2016
Inpatient RN Case Manager/Utilization Review
Clinton Memorial Hospital
01.2012 - 03.2014
Nursing Supervisor
Clinton Memorial Hospital
01.2011 - 03.2014
Registered Nurse Intensive Care/Charge RN
Clinton Memorial Hospital
01.2009 - 03.2014
Bachelor of Science - Nursing
Kaplan University
Associate of Science - Nursing
Southern State Community College
Similar Profiles
Patricia Y. FrazierPatricia Y. Frazier
Enrollment Specialist at HumanaEnrollment Specialist at Humana
Sonya SimsSonya Sims
Medicare Sales Agent at HumanaMedicare Sales Agent at Humana
Jenna G. ThielJenna G. Thiel
Enrollment Representative 1 at HumanaEnrollment Representative 1 at Humana