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Monica Gofron, rn


0000 xxxxxx xxxx , xxxx , xxxxx 00000


Utilization Management ~ Clinical Documentation/Chart Reviews




  Patient-focused Registered Nurse, State of Illinois, offering 20+ years experience; specialization in disease management coaching, consulting, healthcare plan/care reviews and monitoring, and member services/management since 2010

  Qualified to conduct thorough reviews to define appropriate level of care and make informed determinations based on sound clinical/medical judgment and regulatory guidelines

  Excel in strategically prioritizing, coordinating and managing caseload/workflow to optimize productivity and efficiency, maximize use of time and resources and meet stringent deadlines and performance goals

  Vast clinical/direct patient care background as Staff Nurse with additional responsibility for broad-scope administrative functions including insurance pre-certification/verification, scheduling, EMR management, documentation production, and CPT/ICD9 coding

  Effectively interface and collaborate with multidisciplinary medical and industry professionals

  Dynamic patient communication and interpersonal relation skills; adept in counseling and educating patients

  CPR Certified


Recent RN Experience


Nurse Coach Consultant, Active Health Management-Rolling Meadows, IL 2010-Present

  Specializing in Disease Management, effectively educate and manage members with non-acute chronic diseases; expertly define and develop objectives and goals customized to individual member health needs

  Closely monitor and promptly notify members on identified gaps in care or quality concerns vital to optimizing medical treatment plans

  Effectively evaluate member satisfaction and outcome metrics to maximize service quality


Staff Nurse, Fox Valley Women s and Children s Health Partners-St. Charles, IL 2009-2010

  Proficiently performed telephone triage and managed documentation in EMR system

  Efficiently completed detailed FMLA and disability forms using CPT and ICD9 codes in compliance with standards

  Actively assisted physicians with in-office surgical procedures


Staff Nurse, Focus on Woman-St. Charles, IL 2001-2009

  Effectively handled telephone triage and EMR documentation along with surgical procedures scheduling as well as contacted insurance companies to pre-certify all surgeries

  Provided direct patient care and education; included assisting physicians with in-office surgeries and procedures


Prior Nursing Experience Details Available on Request




Diploma of Graduate Nurse, Evangelical School of Nursing-Oaklawn, IL


Undergrad Studies, Loyola University-Chicago, IL

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