Kayla Godwin
Toledo,OH
Summary
Experienced Utilization Review Nurse with strong skills in clinical assessment, documentation, and regulatory compliance. Proven ability to optimize care plans and enhance patient outcomes through critical thinking and strategic resource allocation.
Overview
9
9
years of professional experience
Work History
Utilization Review Nurse
Humana
11.2025 - Current
- Conducted comprehensive utilization reviews to assess medical necessity and appropriateness of patient care.
- Collaborated with healthcare providers to ensure compliance with clinical guidelines and regulatory standards.
- Developed and implemented strategies to optimize resource allocation and improve patient outcomes.
- Reviewed clinical documentation for accuracy, ensuring alignment with payer requirements and minimizing denials.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
MDS Coordinator
The Manor at Perrysburg
06.2023 - 11.2025
- Coordinated comprehensive assessments for residents, ensuring compliance with regulatory standards.
- Developed and implemented strategies to improve care plans based on Minimum Data Set evaluations.
- Trained staff on MDS documentation processes, enhancing accuracy and efficiency across departments.
- Collaborated with interdisciplinary teams to optimize resident care through data-driven insights.
- Analyzed MDS data trends to identify areas for quality improvement initiatives in patient care.
- Oversaw the completion of MDS assessments within deadlines, maintaining high standards of quality control.
- Monitored regulatory changes affecting MDS requirements, ensuring timely updates to nursing practices and policies.
- Assisted with staff onboarding and orientation by providing comprehensive training on the Minimum Data Set process, documentation requirements, and coding guidelines.
- Increased efficiency in MDS completion by developing standardized procedures for data collection, entry, analysis, and submission across multiple departments.
Hospice Registered Nurse Case Manager
Promedica Ebeid Hospice
12.2022 - 06.2023
- Managed comprehensive patient assessments to develop individualized care plans for hospice patients.
- Coordinated interdisciplinary team meetings to ensure cohesive patient care and communication among providers.
- Educated families on end-of-life care options and provided emotional support during challenging transitions.
- Monitored patient progress and adjusted care plans based on evolving medical needs and feedback from caregivers.
- Provided emotional support to patients and their families during the end-of-life process, promoting dignity and comfort.
Telehealth Nurse
Promedica
12.2020 - 07.2022
- Provided comprehensive patient assessments and triaged medical concerns using telehealth platforms.
- Developed care plans tailored to individual patient needs, ensuring adherence to clinical guidelines.
- Educated patients on treatment options and self-management strategies through virtual consultations.
- Collaborated with interdisciplinary teams to coordinate patient care and optimize outcomes remotely.
- Utilized electronic health records to document patient interactions accurately and maintain data integrity.
- Provided emotional support to patients during difficult times, promoting trust between nurse and patient through compassionate virtual interactions.
Registered Nurse, Medical-Surgical Unit, ICU
Regency
02.2019 - 12.2020
- Administered medications and monitored patient responses to ensure optimal care.
- Collaborated with interdisciplinary teams to develop and implement individualized patient care plans.
- Educated patients and families on health management and post-discharge care instructions.
- Conducted comprehensive assessments, identifying critical changes in patient conditions promptly.
Direct Support Professional
Anne Grady
01.2018 - 02.2019
- Assisted individuals with daily living activities, promoting independence and enhancing quality of life.
- Implemented personalized care plans tailored to individual needs and preferences.
- Monitored behavior and emotional well-being, providing support during challenging situations.
- Collaborated with interdisciplinary teams to ensure comprehensive service delivery for clients.
Education
Bachelor of Science - Nursing
Ohio University
Athens, OH05-2023
Associate of Applied Science - Nursing
Owens Community College
Perrysburg, OH12-2018
Skills
- Documentation and reporting
- InterQual criteria
- Utilization review
- Records analysis
- Clinical assessment
- Prior authorization
- Patient care plans
- Quality improvement
- Reliability
- Critical thinking
Timeline
Utilization Review Nurse
Humana
11.2025 - Current
MDS Coordinator
The Manor at Perrysburg
06.2023 - 11.2025
Hospice Registered Nurse Case Manager
Promedica Ebeid Hospice
12.2022 - 06.2023
Telehealth Nurse
Promedica
12.2020 - 07.2022
Registered Nurse, Medical-Surgical Unit, ICU
Regency
02.2019 - 12.2020
Direct Support Professional
Anne Grady
01.2018 - 02.2019
Bachelor of Science - Nursing
Ohio University
Associate of Applied Science - Nursing
Owens Community College