Remote Wound Care UM RN - Utilization Management

Elevance Health; Grand Prairie (TX); Remote; USD 80,000 - 110,000; Full time

Job summary

Elevance Health is seeking a Wound Care Utilization Management RN to perform pre-certification and authorization for Home Health Services for members with wound care needs. You will review records, coordinate with physicians and home health agencies, and ensure appropriate plans of care for continuity of care.

This largely remote role requires in-person training sessions; shifts are Monday–Friday, 8:00 AM–4:30 PM CST. An active RN license plus WOCN/CWS certification is required or preferred.

Qualifications

• RN license required.
• ASN in nursing or equivalent.
• WOCN or CWS certification preferred.
• Ostomy training through accredited programs such as WOCN/ABWM preferred.
• Experience in home health or utilization management preferred.

Responsibilities

• Performs pre-certification and/or authorization for Home Health Services for wound care needs.
• Assesses whether wound care provided aligns with eligibility and benefits coverage.
• Reviews patient records and coordinates with physicians and home health agencies.
• Develops collaborative care plans with providers.
• Monitors delivery of home-based services and continuity of care.
• Provides information resources to patients, families, and care teams.
• Requests additional clinical information as needed and refers non-covered requests for physician review.

Job description

Elevance Health is seeking a Wound Care Utilization Management RN to perform pre-certification and authorization for Home Health Services for members with wound care needs. You will review records, coordinate with physicians and home health agencies, and ensure appropriate plans of care for continuity of care.

This largely remote role requires in-person training sessions; shifts are Monday–Friday, 8:00 AM–4:30 PM CST. An active RN license plus WOCN/CWS certification is required or preferred.