Remote Wound Care UM RN: Pre-Cert & Care Coordination

Elevance Health; Atlanta (GA); Hybrid; USD 90,000 - 110,000; Full time

Job summary

Elevance Health is seeking a Wound Care Utilization Management RN to support pre-certification/authorization for Home Health Services with a focus on wound care. The role ensures appropriate care and continuity by reviewing services and collaborating with providers.

The successful candidate will coordinate care plans with home health agencies and physicians, monitor utilization, and facilitate timely decisions while educating patients on health options.

Qualifications

• ASN in nursing with RN license and 3+ years in varied health care settings.
• Wound care certifications such as WOCN or CWS are required.
• Ostomy training (WOCN or ABWM) and ostomy experience are required.

Responsibilities

• Performs pre-certification and/or authorization activities for Home Health Services for wound care needs.
• Overses members to ensure appropriate wound care and continuity of care.
• Reviews Home health services for clinical appropriateness and discusses plans with providers.
• Communicates with home health agencies and physicians to discuss plans of care.
• Certifications determinations and authorizations to physicians and providers.
• Educates patients to help them understand health options.

Skills

Home health experience

Utilization management

Compact license

Education

ASN in nursing

RN license

WOCN or CWS certification

Ostomy training (WOCN/ABWM)

Job description

Elevance Health is seeking a Wound Care Utilization Management RN to support pre-certification/authorization for Home Health Services with a focus on wound care. The role ensures appropriate care and continuity by reviewing services and collaborating with providers.

The successful candidate will coordinate care plans with home health agencies and physicians, monitor utilization, and facilitate timely decisions while educating patients on health options.