Remote Wound Care UM RN – Precert & Care Coordination

Elevance Health; Mason (OH); Remote; USD 75,000 - 95,000; Full time

Job summary

Elevance Health is seeking a Wound Care Utilization Management RN to support pre-certification and authorization for Home Health Services. This role emphasizes remote work with essential in-person training sessions and a strong focus on care coordination and outcomes.

You will review clinical records, collaborate with providers and home health agencies, and determine appropriate wound care plans while maintaining cost-effective resource use and compliance with coverage guidelines.

Qualifications

• Active RN license required.
• WOCN or CWS wound care certification required.
• Utilization management and home health experience preferred.

Responsibilities

• Performs pre-certification and/or authorization for Home Health Services.
• Develops collaborative care plans with providers and home health agencies.
• Reviews clinical information to determine appropriateness of continued home-based wound care.
• Request additional information as needed to support eligibility and coverage decisions.
• Facilitates timely discharges and transfers based on patient needs.

Skills

RN license

WOCN/CWS

Utilization management

Home health experience

Education

AS in nursing

Job description

Elevance Health is seeking a Wound Care Utilization Management RN to support pre-certification and authorization for Home Health Services. This role emphasizes remote work with essential in-person training sessions and a strong focus on care coordination and outcomes.

You will review clinical records, collaborate with providers and home health agencies, and determine appropriate wound care plans while maintaining cost-effective resource use and compliance with coverage guidelines.