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Abby Goff

@abbygoff

Registered Nurse specialized in utilization review and care coordination.

United States
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What I'm looking for

I seek roles leveraging utilization review and care coordination in collaborative, compliance-focused organizations where I can improve patient outcomes and optimize resource use.

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

DS
Current

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.

SH

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.

Education

Degrees, certifications, and relevant coursework

Ivy Tech Community College logoIC

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.

Tech stack

Software and tools used professionally

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Abby Goff - Utilization Review Nurse - Elevance Health | Himalayas