Denise Wilson
Philadelphia,PA
Summary
Compassionate Registered Nurse with a solid history of achievement in Utilization Nurse Consulting/Case Management and Appeals. I'm a motivated leader with strong organizational and prioritization abilities.
In addition known for high productivity and efficiency in task completion. Specialize in patient care management, healthcare policy implementation, and clinical education. Excel at communication, problem-solving, and adaptability, ensuring seamless coordination between healthcare teams and optimal patient outcomes.
Overview
2026
2026
years of professional experience
6
6
years of post-secondary education
Work History
RN Med-Surg
Pennsylvania Hospital
Philadelphia, PA
04.2025 - Current
- Conducted thorough health assessments to establish baseline patient conditions and identify areas for improvement.
- Provided direct patient care, including administering medications, monitoring vital signs, and assisting with daily activities.
- Collaborated with physicians, nurses, therapists, social workers and other healthcare professionals to develop individualized treatment plans for each patient.
- Maintained a safe environment for all patients by adhering to infection control policies and procedures.
- Monitored vital signs, administered injections, and provided assistance with medical procedures.
- Documented patient progress notes accurately and efficiently in the electronic medical record system.
- Administered medications and treatments, monitoring patients for reactions and side effects.
- Evaluated patients, recognized and addressed complications and coordinated treatment with other members of critical care team.
- Educated patients and families on health management, medication usage, and post-discharge care
- Responded to medical emergencies, utilizing advanced life-saving skills to stabilize patients as needed.
- Participated in quality improvement initiatives aimed at enhancing patient safety and care delivery standards.
- Assisted in the training and mentoring of new nursing staff and nursing students during clinical rotations.
Case Manager II
Scion Health
Philadelphia, PA
06.2022 - 02.2025
- Conducted comprehensive client assessments to identify needs and develop tailored care plans.
- Facilitated multidisciplinary team meetings to coordinate care and ensure seamless service delivery.
- Developed and implemented crisis intervention strategies for clients facing acute health challenges.
- Completed and current reviews for continued stay
- Submitted clinical information via interqual system for discharge planning.
- Elaborated with clinical vendors
- Provided aftercare calls to patient or follow up.
- Conference with physicians regarding patient clinical updates.
- Collaborate with multidisciplinary team.
- members to support patient care needs.
- Provided case management discharge planning services within a LTAC facility
Utilization Nurse Consultant/Case Manager/ Appeals
Aetna
Blue Bell, PA
07.2012 - 05.2022
- Provided managed care services for the Mid Atlantic Region.
- Organized case conferences with Medical Directors regarding patient clinical status pending.
- Processed Medical Director determinations.
- Reviewed request for Pre authorizations for in patient stays and current reviews utilizing, Milliman Guidelines and CMS Guidelines.
- Reviewed patient cases for discharge planning needs and case management engagement.
- Engaged with MDS coordinator, RNAC, and case management for plan of care needs.
- Tasked cased for case management referral and engagement.
- Reviewed patient's benefit for eligibility.
- Led reports to Medical Directors during case rounds.
- Completed and forwarded denial determinations for quality review.
- Analyzed medical data to identify trends and develop strategies for improvement of healthcare services.
- Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
- Collaborated with health groups to plan or implement programs designed to improve overall health of communities.
- Maintained a detailed case management system to track patient progress and outcomes effectively.
Case Manager
Cancer Treatment Centers of America (CTCA)
Philadelphia, PA
11.2010 - 06.2012
- Organizing and coordinating resources and services in response to individual health care needs.
- Coordination of care and services, providing comprehensive assessments to patient with multiple cancer diagnosis.
- Collaboration with multidisciplinary team members.
- Organized and prepped transport for patient with medical emergencies to acute care facilities.
- Collaborated with Oncology physicians and surgeons regarding change in patient medical orders.
- Calls provided to patients regarding Oncology follow up visits.
- Triaged patient regarding side effects of chemotherapy treatments.
- Provided nursing care for patients with various medical diagnoses and treatments.
- Responded quickly and effectively in emergency situations utilizing advanced life saving skills when needed.
- Communicated concerns regarding patients' status, care and environment to nursing supervisors, clinical care supervisors and case managers.
- Collaborated with other healthcare professionals to develop individualized plans of care for each patient.
- Maintained personal and team compliance with medication administration standards and patient care best practices.
- Maintained thorough, accurate and confidential documentation in electronic medical records.
RN med-surge
Pennsylvania Hospital
Philadelphia, PA
Education
ACLS /BLS -
American Heart Association
07.2024 - 12.2025
Certified Case Manager CCM -
Commission For Case Manager Certification
05.2025 - 02.2030
Public Health -
Drexel University
Philadelphia, PANursing (Associate of Applied Science) -
Community College of Philadelphia
Philadelphia, PASkills
- Strong Communication skills
- Computer proficient
- Strong Organizational skills
- Manages in a fast paced high volume environment
- Case management
- Care coordination
- Patient assessment
- Electronic health records
- Data analysis
- Care plan implementation
- Licensed RN
Timeline
Certified Case Manager CCM -
Commission For Case Manager Certification
05.2025 - 02.2030
RN Med-Surg
Pennsylvania Hospital
04.2025 - Current
ACLS /BLS -
American Heart Association
07.2024 - 12.2025
Case Manager II
Scion Health
06.2022 - 02.2025
Utilization Nurse Consultant/Case Manager/ Appeals
Aetna
07.2012 - 05.2022
Case Manager
Cancer Treatment Centers of America (CTCA)
11.2010 - 06.2012
RN med-surge
Pennsylvania Hospital
Public Health -
Drexel University
Nursing (Associate of Applied Science) -
Community College of Philadelphia