Case Management Utilization Review

NICHOLE DAVILA, BSN, RN

**************@*****.*** 863-***-****

PROFESSIONAL SUMMARY

Patient-focused Registered Nurse (BSN) with 7+ years of diverse clinical and leadership experience across acute care, long-term care, and telehealth. Skilled in case management, utilization review, and HEDIS quality measures, with a track record of improving compliance, reducing unnecessary utilization, and enhancing patient outcomes. Adept at patient advocacy, care coordination, and regulatory compliance. Seeking a remote role in case management, utilization review, or Medicare/Medicaid services.

KEY SKILLS

• Case Management & Patient Advocacy

• Utilization Review & Quality Measures (HEDIS, Medicare/Medicaid)

• Insurance Authorization & Appeals Support

• Remote Patient Monitoring (RPM)

• Care Coordination & Interdisciplinary Collaboration

• Preventative Care & Chronic Disease Education

• Clinical Chart Auditing & Documentation Review

• EMR Systems: Epic, Cerner, PCC, AHT, CHIP/CHAW

PROFESSIONAL EXPERIENCE

RN • Health Care Coach Axion Contact (Remote/Telehealth) Apr 2024 – Present

• Provide telephonic coaching to Medicare/Medicaid members, supporting chronic disease management and preventative care.

• Coordinate care plans with providers and interdisciplinary teams to close gaps in HEDIS quality measures.

• Document interventions and track compliance to improve patient outcomes.

RN • Charge Nurse Supervisor The Palms of Sebring Oct 2023 – Feb 2024

• Supervised daily operations of clinical staff, ensuring compliance and quality standards.

• Led shift handoffs and coordinated interdisciplinary communication for safe, efficient care.

RN • Care Team Manager (CTM) The Palms of Sebring Jan 2023 – Jul 2023

• Directed care planning and audits to improve patient safety and regulatory compliance.

• Collaborated with physicians, therapists, and families to optimize care coordination.

RN • Neuro Unit Lakeland Regional Hospital Jul 2022 – Dec 2022

• Delivered bedside care for stroke and trauma patients.

• Assisted with rapid response interventions, reducing ICU transfers.

LPN Roles (2019 – 2022) – MCR Health Services, Polk County Public Schools, Bartow Rehab/LTC

• Managed outpatient care, chronic disease management, and medication administration.

• Provided daily student health support and emergency response.

• Delivered skilled nursing care in rehab and long-term care.

Breastfeeding Peer Counselor & Health Support Specialist Hardee & Polk County Health Dept. 2012 – 2019

• Counseled patients on maternal-child health and preventative care.

• Supported community health programs and WIC services.

EDUCATION & CREDENTIALS

• Bachelor of Science in Nursing–Honors Hillsborough Community College August 2025

• Associate Degree in Nursing Hillsborough Community College May 2022

• Licensed Practical Nurse–Honors Manatee Technical College May 2019

Licensure & Certifications

• Registered Nurse, Florida RN #9603372 COMPACT LICENSE Exp. 04/2026

• BLS Instructor Exp. 09/2027

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