Kelli Nebling

· Reviews and coordinates transplant evaluation requests from initial submission through final determination, ensuring adherence to established selection criteria, policies, and procedures in collaboration with QRM reviewers.

· Refers cases not meeting established healthcare criteria to QRM review physicians, and upon transplant evaluation approval, collaborates with the healthcare team, National Transplant Services (NTS) coordinator, and Center of Excellence (COE) to ensure appropriate resource utilization throughout all phases of transplantation.

· Coordinates, monitors, and tracks all pre-operative testing for members, while demonstrating strong communication skills through effective collaboration with members, families, physicians, and nursing staff to ensure timely appointments and seamless care delivery.

· Effectively manages assigned caseload by monitoring patient status across all phases of care, ensuring completion of necessary laboratory, diagnostic, and other testing to support timely and accurate clinical decision-making.

• Responsible for the day to day timely precertification utilizing established criteria to complete referrals for all members requiring a procedure or service or with an admission diagnosis on the targeted review list for the RN.
• Understands the Complex Case Management Program and admission criteria and refers patients to the Complex Case Managers as appropriate.
• Provide correspondence, written and verbal, in accordance to policy and procedure for members with
• Interacts with physicians to ensure that resources are being utilized appropriately while maintaining quality outcomes.
• Ensures that care is being delivered in the most appropriate setting based on established criteria/guidelines while performing quality of care and service reviews using identified quality indicators.
• Achieves and maintains an understanding of relevant state and federal regulations, criteria, and documentation requirements and laws that affect managed care, home health and case/utilization management.

• Population Care Manager
• Prepares members for dialysis (telephonically educating patients about dialysis modalities) and Renal Transplant as well as participate in teaching monthly Kidney Care Options classes.
• Educates patients on the need for a graft or fistula prior to starting hemodialysis; arranges the procedure in coordination with the Nephrologist and the vascular access nurse.
• Performs outreach to complex chronically ill members while developing high quality specialized treatment plans for each individual member based on specialized needs.
• Assist with decreasing hospital utilization by contacting the patients within 48 hours post discharge to assist post discharge coordination of care.
• Telephonically educates the members about Asthma, Diabetes, Heart Disease, Heart Failure, Lung Disease, CKD/ESRD, and Depression.

• Participate in various charge nurse duties for an 80 + hemodialysis clinic, manage infection control, and anemia management for facility.

• Responsible for the care of 100 + hemodialysis patients and for clinical activities.