Stephanie Marfil
Platteville,CO
Summary
Compact-licensed Registered Nurse with over 7 years of clinical experience and more than 1 year of combined case and utilization management. Proficient in reviewing patient documentation against clinical criteria to identify gaps and ensure accurate medical necessity determinations using interqual guidelines. Experienced in high-volume managed care settings, adept at navigating multiple clinical software systems while producing accurate, compliant review documentation. Strong attention to detail and accuracy in productivity-driven remote environments.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Clinical Review Nurse- Concurrent
Centene
St Louis, Missouri (Remote)
12.2025 - 05.2026
- Reviewed patient clinical documentation against evidence-based criteria, InterQual guidelines, and corporate policies to support accurate medical necessity and authorization determinations.
- Identified incomplete, inconsistent, or missing clinical documentation and escalated cases appropriately to support accurate utilization review determinations
- Maintained accuracy and compliance while processing high volumes of utilization review requests within established turnaround times and productivity expectations.
- Navigated multiple clinical and UM systems in a high-volume managed care environment while maintaining
accuracy and compliance. - Coordinated with physicians, Medical Directors, and interdisciplinary teams to facilitate appropriate clinical
determinations and timely transitions of care. - Identified members requiring additional care coordination or post-acute support and facilitated referrals to care
management teams.
Nurse Care Manager
Centene
St. Louis, Missouri (Remote)
06.2024 - 12.2025
- Managed a caseload of 75+ members across acute, post-acute, and outpatient settings, ensuring appropriate utilization of services.
- Collaborated with providers, facilities, and interdisciplinary teams to coordinate care and reduce avoidable admissions and improve care outcomes.
- Educated members on health plan benefits, preventive care, and community resources to improve engagement
and health outcomes. - Supported team leads by coordinating workflow activities to enhance team efficiency.
- Actively participated in weekly team meetings by sharing ideas and offering solutions when needed.
Clinic Registered Nurse
Castellon Plastic Surgery Center
Melbourne, Florida
02.2023 - 06.2024
- Conducted preoperative evaluations to determine medical suitability for elective procedures, enhancing patient safety.
- Developed individualized care plans and coordinated multidisciplinary referrals, improving patient outcomes.
- Educated patients and families on treatment expectations and recovery protocols, promoting informed decision-making.
Critical Care Registered Nurse
Health First Palm Bay Hospital
Palm Bay, Florida
11.2021 - 02.2023
- Delivered high-acuity care to critically ill patients in a 12-bed ICU within a 120-bed hospital, including ventilator management, hemodynamic monitoring, and complex medication administration.
- Participated in daily interdisciplinary rounds with physicians, case managers, social workers, pharmacists, and charge nurses to evaluate care plans, acuity levels, and discharge readiness.
- Prioritized patient care assignments based on patient conditions to achieve optimal outcomes.
Progressive Care Registered Nurse
Health First Palm Bay Hospital
Palm Bay, Florida
09.2020 - 11.2021
- Provided comprehensive care to patients in a 40-bed progressive care unit, managing up to 6 patients requiring continuous cardiac and hemodynamic monitoring.
- Collaborated with interdisciplinary teams to coordinate patient care and ensure safe discharges.
- Mentored new nurses and nursing assistants, fostering teamwork and promoting clinical excellence within the unit.
Nurse Technician/Unit Secretary
Health First Palm Bay Hospital
01.2017 - 09.2020
- Assisted nursing teams in caring for 20+ patients per shift by monitoring vital signs, performing EKGs, collecting specimens, and supporting activities of daily living.
- Managed 50+ admission, discharge, and transfer records weekly, ensuring accurate documentation and compliance with hospital protocols to facilitate patient flow.
Education
Associate of Science - Nursing
Eastern Florida State College
Cocoa, FL05-2020
Skills
- Interqual Criteria/NCQA Standards
- Clinical Documentation Review
- Clinical Documentation Systems
- EMR/EHR Systems
- Utilization Management Platforms
- Microsoft Office Suite
- Remote Workflow Systems
- Critical Care
- Acute Care
- Documentation Compliance
- Data Entry Accuracy
- Critical Thinking
- Adaptability
Certification
- Compact License Registered Nurse (RN) Florida State Board of Nursing, license #RN9546537, expires 07/31/2026
- Registered Nurse (RN) Nevada State Board of Nursing, license #886498, expires 01/31/2027
Timeline
Clinical Review Nurse- Concurrent
Centene
12.2025 - 05.2026
Nurse Care Manager
Centene
06.2024 - 12.2025
Clinic Registered Nurse
Castellon Plastic Surgery Center
02.2023 - 06.2024
Critical Care Registered Nurse
Health First Palm Bay Hospital
11.2021 - 02.2023
Progressive Care Registered Nurse
Health First Palm Bay Hospital
09.2020 - 11.2021
Nurse Technician/Unit Secretary
Health First Palm Bay Hospital
01.2017 - 09.2020
Associate of Science - Nursing
Eastern Florida State College