Ashlynne Goldberg
Greenfield,WI
Summary
Registered Nurse with inpatient case management experience specializing in utilization review, medical necessity determination, and care coordination across ICU, ED, and med/surg populations. Skilled in evaluating appropriate level of care, managing length of stay, and collaborating with interdisciplinary teams and payers to support optimal patient outcomes. Experienced in clinical chart review, documentation for insurance compliance, and independent decision-making in fast-paced environments. Seeking a remote utilization review or appeals/denials role.
Overview
7
7
years of professional experience
Work History
Inpatient RN Case Manager (ICU, ED, Med/surg)
Ascension
Milwaukee, WI
01.2025 - Current
- Perform utilization review of inpatient cases to assess medical necessity and appropriate level of care
- Apply utilization management guidelines to support efficient resource use and optimize length of stay
- Conduct detailed clinical chart reviews to support care planning and payer requirements
- Collaborate with interdisciplinary teams to address barriers to discharge and ensure timely transitions of care
- Coordinate complex discharge planning while maintaining focus on patient safety and appropriate resource utilization
- Complete thorough documentation to support medical necessity determinations and insurance review processes
- Contribute to readmission reduction through proactive care coordination and follow-up planning
- Maintain independent decision-making while managing a high-acuity caseload
Home Health RN Case Manager
Aurora Health Care
Milwaukee, WI
05.2024 - 12.2024
- Managed patient cases in the home setting, coordinating care plans and monitoring clinical progress
- Assessed patient conditions and adjusted care based on clinical findings and evidence-based practice
- Educated patients and families on disease management, medications, and post-acute care needs
- Facilitated referrals and services to support continuity of care and prevent hospital readmissions
- Documented patient status and interventions in compliance with regulatory and payer guidelines
Director of Nursing
Koru
Mequon, WI
06.2023 - 05.2024
- Oversaw daily nursing operations, ensuring compliance with CMS and regulatory standards
- Supervised and supported nursing staff, including scheduling, performance management, and training
- Implemented policies and procedures to maintain quality and safety standards
- Led team communication and process improvements to enhance patient care delivery
Travel Registered Nurse (Cardiac, Neuro, Ortho)
Host Healthcare
Wisconsin
07.2021 - 06.2023
- Provided care for high-acuity patients across multiple specialties in fast-paced hospital settings
- Utilized critical thinking to assess, plan, and implement patient care
- Responded to emergencies and collaborated with healthcare teams to ensure patient safety
Registered Nurse (Bedside)
Froedtert & Ascension
Milwaukee, WI
05.2019 - 06.2021
- Delivered direct patient care and coordinated discharge planning activities
- Collaborated with interdisciplinary teams to ensure continuity of care
- Built strong communication skills supporting patients and families during complex care situations
Education
Bachelor of Science - Nursing
Western Governors University
Salt Lake City, UTAssociate of Science - Nursing
Western Technical College
La Crosse, WISkills
- Reduced hospital readmissions through effective utilization management and care coordination
- Managed complex, high-acuity patient cases requiring strong clinical judgment and independent decision-making
- Recognized for clear, concise documentation supporting medical necessity and payer compliance
Timeline
Inpatient RN Case Manager (ICU, ED, Med/surg)
Ascension
01.2025 - Current
Home Health RN Case Manager
Aurora Health Care
05.2024 - 12.2024
Director of Nursing
Koru
06.2023 - 05.2024
Travel Registered Nurse (Cardiac, Neuro, Ortho)
Host Healthcare
07.2021 - 06.2023
Registered Nurse (Bedside)
Froedtert & Ascension
05.2019 - 06.2021
Bachelor of Science - Nursing
Western Governors University
Associate of Science - Nursing
Western Technical College