Kevanya C. Golden
BSN Registered Nurse
Greenville,SC
Summary
As a BSN-prepared registered nurse, my mission is to help drive positive patient outcomes and improve healthcare delivery through effective leadership, collaboration, and innovation. I am well-equipped to lead and inspire healthcare teams to deliver exceptional care with a strong foundation in nursing theory and practice and advanced training in clinical leadership, healthcare management, and quality improvement. My experience in patient care, staff development, and healthcare leadership is complemented by my exceptional communication and interpersonal skills, which enable me to build strong relationships with patients, families, and healthcare professionals. I have experience leveraging data and technology to drive evidence-based care decisions and am skilled in utilizing quality improvement methodologies to drive continuous improvement in healthcare delivery. Ultimately, my mission is to serve as a transformative leader in the nursing profession, leveraging my skills and expertise to drive positive change in healthcare delivery, improve patient outcomes, and foster a culture of excellence and innovation.
Overview
17
17
years of professional experience
3
3
Certifications
Work History
Post-Acute Utilization Management Nurse Consultant
Aetna, A CVS Health Company
WAH, SC
01.2020 - Current
- Evaluate medical guidelines and benefit coverage to determine the appropriateness of services
- Examine clinical programs information to identify members for specific case management and/or disease management activities or interventions by utilizing established screening criteria
- Work collaboratively with the Medical Directors to ensure guidelines consistent with Medicare and NCQA requirements are met with each clinical review
- Conducts Medicare and Commercial post-acute precertification and concurrent reviews
- Serves on multiple committees, helping identify opportunities to improve processes
Acute Utilization Management Nurse II-Front End
Humana
WAH, SC
01.2018 - 09.2019
- Supervised and managed a team of nurses, including delegating tasks, providing guidance and support, and conducting performance evaluations.
- Participated in quality improvement initiatives, such as implementing best practices and monitoring patient outcomes.
- Managed network participation, care with specialty networks, care with DME providers, and transfers to alternative levels of care using knowledge of benefit plan design.
- Effectively managed a metric of 10-12 clinical reviews per day.
- Identified potentially unnecessary services and care delivery settings and recommended alternatives if appropriate by analyzing clinical protocols, such as observation level vs. inpatient level of care.
- Examined clinical program information to identify members for specific case management and/or disease management activities or interventions by utilizing established screening criteria.
- Worked collaboratively with the Medical Directors implementing medical policies and guidelines consistent with Medicare and NCQA requirements.
- Conducted admission reviews, post-discharge calls, and discharge planning.
SNF Onsite Transition of Care Nurse
Humana
WAH, SC
01.2017 - 01.2018
- Worked with identified health plan Medicare Advantage members currently in select skilled nursing facilities to coordinate interventions and services to meet their healthcare needs upon discharge.
- Communicated face-to-face with members, providers, and Humana associates to promote efficient optimal care and treatment.
- Utilized knowledge of benefit plan design and care alternatives available within the community and nationally to recommend services that represent the delivery of appropriate health care services for Humana Medicare Advantage Plan members as ordered by the member's care provider (DME, Home Health, Follow-up Appointments, etc...).
- Collaborated in the discharge planning activities with the facility team and the health plan.
- Made decisions regarding own work methods, occasionally in ambiguous situations, while requiring minimal direction.
Transcend Care Coach
Humana
WAH, SC
09.2016 - 01.2017
- Assisted in care planning, implementing, and evaluating interventions to meet patients' and family needs when appropriate.
- Telephonically communicated with patients and providers to schedule members for annual check-ups and preventive care appointments (HEDIS measures).
- Coordinated and evaluated the management of patients with acute and chronic conditions and patients discharged from acute facilities to achieve high-quality care and prevent re-admissions.
- Facilitated connections to community support groups and resources.
- Educated and taught patients and families about diseases and procedures that directly affected the patient.
- Remained updated on current NCQA regulations, especially concerning HEDIS Measures.
Acute Onsite Clinical Advisor RN
Humana
WAH, SC
06.2013 - 09.2016
- Worked with identified health plan Medicare Advantage members currently in acute care facilities to coordinate interventions and services to meet their healthcare needs upon discharge.
- Communicated face-to-face with members, providers, and Humana associates to promote efficient optimal care and treatment.
- Performed concurrent and retro review of acute and sub-acute services, as well as precertification review for all services following the plans authorization guidelines
- Knowledge of benefit plan design and care alternatives available within the community and nationally to recommend services that represent the delivery of appropriate health care services for Humana Medicare Advantage Plan members as ordered by the member's care provider (DME, Home Health, Follow-up Appointments, etc...).
- Collaborated in the discharge planning activities with the facility team and the health plan.
- Made decisions regarding own work methods, occasionally in ambiguous situations, requiring minimal direction.
Integrated Case Manager
Greenville Health System
Greenville, SC
04.2012 - 06.2013
- Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and document patient interactions and interventions in electronic charting systems.
- Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs.
- Identified medically complex patients and facilitated access to services to promote quality outcomes.
- Served as a patient advocate.
- Enhanced a collaborative relationship to maximize the patient's and family's ability to make informed decisions.
- At the request of third-party payers, provided initial, concurrent, and retrospective reviews to extend authorized days and ensure reimbursement due for services provided.
RN Case Manager
Heartland Hospice
Greenville, SC
06.2011 - 04.2012
- Provided primary care to home and facility-based hospice patients.
- Worked closely with the interdisciplinary team to ensure patients received quality care.
- Developed and implemented individualized care plans for each hospice patient while following physician instructions.
- Taught family members and caregivers various ways to manage patients' pain, how to check for vital signs, and proper methods for dressing changes.
- Established and maintained successful relationships with patients, families, and physicians through exemplary communication and active listening skills.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols to optimize performance and safety.
Director Of Nursing (DON)/ RN Case Manager
Journey Hospice
Greenville, SC
06.2009 - 03.2011
- Developed and implemented patient care services and budgets for the department and prepared reports and quality improvement with the implementation of performance improvement projects.
- Oversaw a staff of 15+ nurses, aides, and other clinical disciplines.
- Ensured all nurses were keeping accurate records with chart audits.
- Interviews and hires of new nursing staff members.
- Investigated and independently resolved complaints from staff, physicians, and patients by leveraging clinical judgment and management expertise.
- Taught family members and caregivers various ways to manage patients' pain, how to check for vital signs, and proper methods for dressing changes.
- Established and maintained successful relationships with patients, families, and physicians through exemplary communication and active listening skills.
LTAC Charge Nurse; PICC RN
Regency Hospital Of Greenville
Greenville, SC
05.2006 - 06.2009
- Made daily assignments and delegated tasks to appropriate disciplines.
- Provided care to acutely ill/ventilated patients.
- Reported to physicians any changes in the patient's condition, emphasizing assessment, illness prevention, and health care management.
- Participated in MD rounds.
- Responded quickly to changes in patient's conditions.
- Assisted physicians with bedside procedures in ICU and Med-Surg areas.
- Acted as a liaison between patients, physicians, and other healthcare providers.
- Implemented and maintained established policies, procedures, objectives, quality assurance, safety, environmental and infection control, etc.
- Certified PICC RN
Education
Bachelor of Science - Nursing
South University Online
Savannah, GA 05.2001 -
Skills
Medicare/Medicaid
Microsoft Office Suite, including ExcelAbility to interact professionally with staff, physicians, and payersDemonstrates ability to manage complex clinical situationsAbility to work and function independentlyUnderstands and complies with all regulatory, procedural, and policy requirementsEHR Systems: EPIC, CERNER, ALLSCRIPTSMCG and InterQual proficientProcess ImprovementQuality Control/Quality Improvement
Exceptional Problem SolverConflict ResolutionHighly OrganizedDischarge planning coordination
Interpersonal and written communication
Utilization Management/Review
Certification
Licensed Registered Nurse
Timeline
Post-Acute Utilization Management Nurse Consultant
Aetna, A CVS Health Company
01.2020 - Current
Acute Utilization Management Nurse II-Front End
Humana
01.2018 - 09.2019
SNF Onsite Transition of Care Nurse
Humana
01.2017 - 01.2018
Transcend Care Coach
Humana
09.2016 - 01.2017
Acute Onsite Clinical Advisor RN
Humana
06.2013 - 09.2016
Integrated Case Manager
Greenville Health System
04.2012 - 06.2013
RN Case Manager
Heartland Hospice
06.2011 - 04.2012
Director Of Nursing (DON)/ RN Case Manager
Journey Hospice
06.2009 - 03.2011
LTAC Charge Nurse; PICC RN
Regency Hospital Of Greenville
05.2006 - 06.2009
Bachelor of Science - Nursing
South University Online
05.2001 -