Holly McClelland

Assessment of member's healthcare needs. Provides coordination of resources to promote quality outcomes for health plan members' wellness. Provide member education of health conditions and navigation of healthcare services. Develop personalized Plans of Treatment/Care to maximize efficient use of health services.

• Collaborated with multidisciplinary teams to address client needs and formulate tailored support strategies.
• Onsite discharge planning and coordination for customers admitted to Einstein Medical Center in Philadelphia. Collaboration with hospital employed Case Managers.
• Utilization Review of Acute, Observation, Acute Rehabilitation, and LTAC-Long Term Acute Care Transitions of Care. Ambulance Transport Authorizations for inpatient customers
• Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
• Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
• Facilitated successful transitions between levels of care by developing detailed discharge plans and coordinating resources.

• Utilization Review for Home Health and Home Infusion Services based on medical necessity. Elevated requests to Medical Directors in event of standardized criteria not being met. Issued approvals and denials to Health Care provider with rationale for denials.
• Collaborated with providers to ensure quality care for health plan members.
• Home Infusion authorizations included calculating Medication dosages and assessing orders for appropriateness and quality of care

• Provided education and training to a group of entrepreneurs planning to open a Medicare Certified Home Health Agency in the local region.
• Education/training included all aspects of both clinical and non clinical roles and responsibilities of the professional Home Health Nurse and Nurse manager

• Served primarily as field clinician however, to serve the needs of new and expanding Home Health Agency served in various roles including interim Nurse Manager, Educator, Clinical Liaison and Managed Care Insurance Authorization Specialist This was part time position that supplemented work for Penn Care at Home.

Educated patients, family members and caregivers about medical conditions and medical procedures post hospital discharge promoting self management and independence.

Served as a Health Care Advocate.

Taught patients, family members and caregivers how to be an advocate and to navigate the healthcare system.

Served as a Nurse Preceptor to new employees

Active member of both the Quality Improvement Committee and the Committee for creating Clinical Pathways.

• Improved patient outcomes by providing high-quality nursing care and implementing evidence-based practices.
• Enhanced patient satisfaction through effective communication, empathy, and timely response to their needs.
• Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
• Administered medications accurately and safely, reducing medication errors and adverse reactions.