MELISSA MARIEANNE GOODS
Orlando
Summary
Offering abilities in healthcare coordination and patient care management, with strong analytical and organizational skills. Experienced in utilization review processes, compliance standards, and developing effective professional relationships. Skilled in customer support and communication, ensuring efficient healthcare service delivery.
Overview
22
22
years of professional experience
8022
8022
years of post-secondary education
1
1
Certification
Work History
Clinical Intake Manager
ADVENTHEALTH
Altamonte Springs
08.2025 - Current
- Provided case management services to assist clients in accessing resources to meet their health and social service needs.
- Assessed patient's physical, psychological, social, and spiritual needs in order to develop an individualized plan of care.
- Established a strong rapport with clients by providing compassionate care.
- Managed complex cases involving multiple diagnoses requiring specialized treatment plans.
- Facilitated discharge planning activities such as arranging follow up appointments or home health services when necessary.
- Utilized critical thinking skills to analyze patient data and develop individualized plans of care.
- Coordinated referrals between primary care physicians and other specialists as needed.
- Maintained up-to-date knowledge of current trends and best practices within the field of referral nursing.
- Served as a liaison between referring providers and specialty clinics when necessary.
- Developed strong relationships with referring providers through effective communication and collaboration.
Utilization Review Nurse
WIN HEALTHCARE
Greenwich
04.2018 - 07.2025
- Acts as a resource and decision making party to ensure that a clinically sound decision is administered.
- Works collaboratively with other departments to implement policies and procedures that directly impact the specialties benefit.
- Educates external providers about HPHC's utilization management guidelines for specialty services.
- Receives incoming requests for specialty services; coordinates receipt of patient medical records and related clinical information.
- Complies with all regulatory and accreditation agency standards.
- Actively participated in team meetings and case conferences to identify issues, research problems and develop/implement solutions; work effectively with other internal departments for problem identification and resolution.
- Reviews and processes authorization review requests for determinations within regulatory turnaround time.
- The Nurse performs special projects or other assignments as requested by the Supervisor, Manager or Director.
- Adheres to accreditation, contractual and regulatory timeframes in performing all utilization management review processes.
- Analyzed patient records to determine whether requested services met established criteria for medical necessity.
- Collaborated with medical units to formulate thorough evaluation of care proceedings.
- Developed comprehensive discharge plans that included post-acute care options when appropriate.
- Provided feedback on denials and approvals to provider staff on a regular basis through verbal or written communication methods.
- Performed utilization reviews for inpatient and outpatient services to ensure medical necessity, appropriateness of care and level of service according to state and federal regulations.
- Conducted concurrent reviews for inpatients using InterQual criteria, managed care policies and other resources such as Milliman Care Guidelines.
- Utilized clinical judgment to evaluate the need for continued treatment or alternative levels of care based on patient's condition, diagnosis and insurance guidelines.
- Reviewed authorization requests for accuracy prior to processing.
- Mediated communication between care providers and patients for clarifying treatment options.
Nurse Coordinator
NORTH HUDSON IVF CENTER
Englewood Cliffs
05.2013 - 04.2018
- Welcome donors via telephone; answer inquiries and provide in depth information on the donation process, answer basic non-clinical questions, and convert donor inquiries into appointments.
- Oversees preliminary screening of donors, including the application process, facilitate donor screenings including blood testing, ultrasound scans, physicals and consultations.
- Maintain donor base data system, track donor process and follow up on outstanding screening, prepare donor charts and match weekly; coordinate and attend meetings, update donors and notify of acceptance or rejection.
- Work closely with the donor and Marketing Departments to assist with and ensure success of donor recruitment events/activities.
- Coordinates donor process, which includes issuing new donor numbers, scheduling/conducting new donor orientations, obtaining necessary consents, compiling donor charts, ensuring completion of program requirements, and preparing charts for medical.
- Developed strong relationships with patients, staff and physicians to ensure effective communication of health care needs.
- Maintained knowledge base of current regulations governing practice of nursing as well as hospital policies and procedures related to nurse coordination role.
- Performed chart audits to ensure accuracy of medical records and compliance.
- Assisted in the creation of educational materials for use by patients regarding IVF processes and egg donation programs.
- Conducted research into new technologies that can be used to improve outcomes in fertility treatments.
Pre Operative Clinical Nurse Reviewer
MORRIS COUNTY SURGICAL CENTER
Parsippany
05.2011 - 05.2013
- Utilized specialized nursing knowledge and discriminative judgment while giving direct and indirect patient care.
- Answered and responded to all calls in an appropriate time frame for patients scheduled for proposed surgeries.
- Responsible for patient's admission and pre-operative care via outbound calls; holistic preparation for surgery, considering all needs, including pre-operative education, escort/family members, psychosocial needs, utilizing preference cards, and acting under established protocols, practices, and standing orders.
- Coordinated pre-operative lab work required for individual patients, documenting and reporting pertinent results via inbound and outbound calls.
- Responsible for the patient's post-operative care and stabilization.
- Performed thorough and accurate continual patient assessment completed via telephone, anticipating potential problems via inbound/outbound call and reporting pertinent assessments to the anesthesiologist, supervisor, and/or surgeon appropriately.
- Documented actions in medical record completely and accurately in a timely manner.
- Acted as discharge nurse when assigned, giving holistic and thorough discharge education.
- Participated as a team member in planning and implementation of patient care; took responsibility for an adequate patient load, reviews schedule for next day.
- Conducted all post-operative phone calls, assessing patient status and reporting any pertinent information.
- Performed comprehensive assessments of diagnoses, treatments, medications, laboratory results, diagnostic tests.
- Generated reports summarizing results from case reviews and other relevant information.
- Facilitated peer-to-peer discussions regarding complex cases or treatment decisions.
- Collaborated with multidisciplinary teams to facilitate effective communication and coordination of patient care services.
Clinical Nurse Coordinator
DIAMOND INFERTILITY INSTITUTE
Millburn
10.2009 - 05.2011
- Coordinated IVF and IUI cycles for patients as directed by practice physicians.
- Responsible for ensuring all required labs and procedures are completed and documented.
- Communicated with patients regarding lab results with clear interpretation and explanation.
- Provide patient counseling and education.
- Documented accurately all patient care services in ArtWorks.
- Triaged all patient phone calls and other communications.
- Ensured quality and accuracy of materials provided to patients.
- Communicated physician orders and instructions to patients.
- Reviewed patient charts for medical issues which may require evaluation before proceeding with IVF cycle.
- Communicated with all staff, clinical and administrative in order to provide high quality patient care.
- Liaised cross-functionally to coordinate and integrate patient care services.
- Developed and maintained positive relationships with patients, families, staff members, physicians, and other healthcare providers.
Surgical/Billing Coordinator
UNION PLAINFIELD MEDICAL ASSOCIATES
Plainfield
05.2004 - 04.2007
- Responsible for scheduler activities including but not limited to:
- Maintain surgical calendar to ensure appropriate coverage and Physician availability.
- Schedule surgical procedures for patients on-site at physician offices, Office Based Surgical Suites and/or at off-site facilities.
- Inform patient of all pre-admission testing required.
- Obtains all medical clearances and insurance pre-certifications required for all procedures.
- Enter all authorizations, PATs and other pertinent information into EMR accurately.
- Function as liaison between Physician, operating room scheduler/system, off-site facility/hospital and patient.
- Ensure the surgical facility has all required paperwork, clearances, etc.
- Establish and maintain open communication with appropriate departments, other offices and off-site facilities.
Education
Licensed Practical Nursing Program - LPN Diploma -
Technical Education Center Osceola
Kissimmee, FloridaSanford Brown Institute
Iselin, New JerseyFelician College
Lodi, NJHigh School -
Mother Seton Regional All Girls High School
Skills
- Assessment and documentation
- Compliance procedures
- Telephonic nursing
- Care planning support
- Clinical judgment
- Patient education
- Clinical assessment
- Insurance verification
- Quality improvement strategies
- Discharge planning
- Managed care practices
- Utilization review
Certification
- CPR/BLS
- Florida LPN
- New Jersey LPN
Timeline
Clinical Intake Manager
ADVENTHEALTH
08.2025 - Current
Utilization Review Nurse
WIN HEALTHCARE
04.2018 - 07.2025
Nurse Coordinator
NORTH HUDSON IVF CENTER
05.2013 - 04.2018
Pre Operative Clinical Nurse Reviewer
MORRIS COUNTY SURGICAL CENTER
05.2011 - 05.2013
Clinical Nurse Coordinator
DIAMOND INFERTILITY INSTITUTE
10.2009 - 05.2011
Surgical/Billing Coordinator
UNION PLAINFIELD MEDICAL ASSOCIATES
05.2004 - 04.2007
Licensed Practical Nursing Program - LPN Diploma -
Technical Education Center Osceola
Sanford Brown Institute
Felician College
High School -
Mother Seton Regional All Girls High School