Abby Goff
@abbygoff
Registered Nurse specialized in utilization review and care coordination.
What I'm looking for
I am an experienced Registered Nurse with a strong specialization in Utilization Review, bringing several years of clinical and payer-focused experience across acute care settings. I combine frontline nursing skills with standardized utilization criteria to support appropriate, evidence-based care decisions.
At Elevance Health and Deaconess Health System I conduct medical necessity reviews, apply MCG and InterQual criteria, and coordinate with multidisciplinary teams and physician advisors to optimize patient placement and resource use. I manage high-volume workflows and ensure compliance with payer and regulatory requirements.
My clinical background includes ICU, pre-op/PACU, and general acute care nursing, which strengthens my assessment skills and ability to advocate for patients. I routinely perform chart audits, communicate with payers, and submit clinical documentation to secure appropriate coverage.
I am committed to improving patient experiences through accurate utilization management, clear payer communication, and collaboration with care teams to promote safe, efficient care delivery.
Experience
Work history, roles, and key accomplishments
Conduct utilization review for diverse member populations, ensuring compliance with payer and regulatory requirements and providing evidence-based clinical recommendations to optimize resource use and patient outcomes.
Utilization Review Nurse
Deaconess Health System
Nov 2020 - Present (4 years 11 months)
Managed bed status and admission orders for ~90 patients daily, submitted clinical documentation to insurers, and applied MCG/InterQual criteria while collaborating with physician advisors to ensure appropriate patient placement and coverage.
Pre-op/PACU RN
Deaconess Health System
Mar 2018 - Nov 2020 (2 years 8 months)
Performed pre-op assessments and post-anesthesia care for critical patients, coordinating with anesthesiologists and surgeons to ensure safe recovery and optimal perioperative outcomes.
Registered Nurse
St. Vincent's Hospital
Dec 2017 - Mar 2018 (3 months)
Provided patient assessments, medication administration, and collaborated with physicians to deliver quality acute care across assigned units.
Student Nurse Extern
St. Vincent's Hospital
Mar 2016 - Dec 2017 (1 year 9 months)
Supported RNs with patient assessments, documentation, and medication administration under supervision, gaining hands-on clinical experience.
Patient Care Technician
St. Vincent's Hospital
Sep 2014 - Mar 2016 (1 year 6 months)
Assisted patients with activities of daily living, documented vital signs, and supported nursing staff in delivering patient care.
Education
Degrees, certifications, and relevant coursework
Ivy Tech Community College
Associate of Science in Nursing, Nursing
Completed an Associate of Science in Nursing focused on foundational nursing practice and clinical skills preparation for licensure.
Availability
Location
Authorized to work in
Job categories
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