Remote Wound Care Utilization Management RN

The Elevance Health Companies, Inc.; Grand Prairie (TX); Hybrid; USD 85,000 - 110,000; Full time

Job summary

Elevance Health is seeking a Wound Care Utilization Management RN to work primarily virtually with periodic in-person training sessions. The role requires an active RN license, WOCN or CWS certification, and at least 3 years in diverse health care settings.

The RN will coordinate care plans, review home-based services, and discuss plans of care with providers. Hybrid work arrangement applies, with in-person onboarding and ongoing collaboration across care teams.

Qualifications

• Requires ASN in nursing and active RN license.
• WOCN or CWS certification required.
• Ostomy training through accredited programs required.
• Minimum 3 years of health care experience in varied settings.

Responsibilities

• Develops coordinated collaborative care plans with providers.
• Reviews Home based services for clinical appropriateness of continued care.
• Performs reviews telephonically/virtually/remotely using medical records.
• Connects with home care agency and physicians to discuss plan of care.
• Promotes healing and decreased home care utilization.
• Responsible for certification determinations and authorizations.
• Requests additional clinical information from care providers as needed.
• Facilitates timely discharges and transfers based on needs.
• Educates patients to help them understand health choices.
• Serves as information resource to patients' care teams and family.
• Monitors cost-effective resource use and recommends alternatives.
• Refer requests not meeting guidelines to physician for review.
• Uses clinical judgment in authorizations outside guideline parameters.

Skills

Utilization Management

Home health experience

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 work primarily virtually with periodic in-person training sessions. The role requires an active RN license, WOCN or CWS certification, and at least 3 years in diverse health care settings.

The RN will coordinate care plans, review home-based services, and discuss plans of care with providers. Hybrid work arrangement applies, with in-person onboarding and ongoing collaboration across care teams.