Ashlye Kehrer
Rowlett
Summary
Experienced and compassionate Nurse Case Manager with a strong background in coordinating comprehensive care plans for diverse patient populations. Skilled in clinical assessment, discharge planning, and resource utilization to ensure high-quality, cost-effective outcomes. Proven ability to manage caseloads efficiently while maintaining a patient-centered approach, and compliance with regulatory standards.
Overview
15
15
years of professional experience
Work History
Telephonic Nurse Case Manager
Opus Medical
Dallas
05.2013 - 09.2025
- Developed case management plans that incorporated medical necessity criteria from payers, and other resources.
- Conducted utilization reviews, concurrent reviews, authorization requests, and discharge planning.
- Monitored treatment progress by reviewing medical records, lab results, and physician notes.
- Performed occasional field visits to provider offices and hospital facilities to complete in-person evaluations and ensure continuity of care.
- Reviewed coverage determinations, investigated, and evaluated claims.
- Facilitated communication between physicians, nurses, allied health practitioners, and administrative staff to ensure optimal outcomes for patients.
- Analyzed and extracted pertinent medical information from patient records for data entry into the electronic health record system.
- Investigated potential fraudulent activities related to claims.
- Researched discrepancies in claim information to determine the appropriate resolution.
- Implemented physician recommendations and monitored patient progress through evaluations and follow-up assessments, ensuring appropriate care adjustments.
- Assess the liability risks associated with submitted claims.
- Developed and executed comprehensive plans for complex cases for over 75 case loads monthly.
- Managed referral processes and coordinated services with vendors, enhancing efficiency and reducing patient wait times for critical interventions.
Urgent Care Nurse
Care Now
Garland
01.2011 - 05.2013
- Delivered rapid assessment, triage, and treatment in a high-volume urgent care setting.
- Administered medications, performed wound care, EKGs, splinting, and other urgent care procedures.
- Collaborated with physicians, nurse practitioners, and interdisciplinary staff to manage acute illnesses, injuries, and chronic condition flare-ups.
- Educated patients and families on discharge instructions, follow-up care, and preventive health practices.
- Maintained compliance with infection control, medication safety, and documentation standards.
- Conducted telephone triage assessments, gathering patient symptoms and histories to determine the appropriate level of care.
- Monitored and maintained the medical supply inventory to ensure the availability of critical equipment in an urgent care setting.
Education
LVN - Nursing
Dallas Nursing Institute
Dallas11-2010
Skills
- Utilization review
- Case management planning
- Medical record analysis
- Claims investigation
- Compliance auditing
- Healthcare coordination
- Electronic health record
- Work Independently
Timeline
Telephonic Nurse Case Manager
Opus Medical
05.2013 - 09.2025
Urgent Care Nurse
Care Now
01.2011 - 05.2013
LVN - Nursing
Dallas Nursing Institute