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Wound Care UM RN

  • Job Family: Medical and Clinical
  • Type: Full time
  • Date Posted:
  • Anticipated End Date:
  • Reference: JR104797

Location:

  • WA, SEATTLE
  • PA, SEVEN FIELDS
  • VA, ARLINGTON
  • MA, BOSTON
  • IN, INDIANAPOLIS
  • OH, CINCINNATI
  • NY, NEW YORK
  • CT, ROCKY HILL
  • CA, RANCHO CORDOVA
  • MI, WIXOM
  • NE, LINCOLN
  • TN, BRENTWOOD
  • DC, WASHINGTON
  • MD, ANNAPOLIS
  • NV, LAS VEGAS
  • MN, MENDOTA HEIGHTS
  • TN, KNOXVILLE
  • MO, COLUMBIA
  • VA, ASHBURN
  • OH, COLUMBUS
  • NC, CARY
  • WA, LAKEWOOD
  • WI, MADISON
  • WV, CHARLESTON
  • DE, WILMINGTON
  • NE, OMAHA
  • OH, SEVEN HILLS
  • RI, SMITHFIELD
  • NC, WINSTON
  • GA, ATLANTA
  • DC, WASHINGTON
  • IL, DEERFIELD
  • VA, RICHMOND
  • FL, TAMPA
  • FL, ALTAMONTE SPRINGS
  • FL, TALLAHASSEE
  • KS, TOPEKA
  • VA, ROANOKE
  • NY, Lake Success
  • CO, COLORADO SPRINGS
  • FL, JACKSONVILLE
  • CA, WOODLAND HILLS
  • WI, Waukesha
  • NJ, MORRISTOWN
  • MO, JEFFERSON CITY
  • TN, MEMPHIS
  • OH, MASON
  • NY, ALBANY
  • CA, SACRAMENTO
  • CA, WALNUT CREEK
  • PA, HERMITAGE
  • KY, LOUISVILLE
  • NH, MANCHESTER
  • TX, GRAND PRAIRIE
  • IL, CHICAGO
  • TX, AUSTIN
  • MI, DEARBORN
  • VA, CHESAPEAKE
  • TN, NASHVILLE
  • MN, GILBERT
  • LA, METAIRIE
  • NY, MIDDLETOWN
  • AR, LITTLE ROCK
  • IL, SPRINGFIELD
  • GA, MIDLAND
  • TX, HOUSTON
  • VA, NORFOLK
  • CA, LOS ANGELES
  • CT, WALLINGFORD
  • MO, ST LOUIS
  • CA, COSTA MESA
  • MD, HANOVER
  • NJ, ISELIN
  • CA, CERRITOS
  • OH, MASON
  • IL, CHICAGO
  • CO, DENVER
  • NV, LAS VEGAS
  • CA, PALO ALTO
  • ME, SOUTH PORTLAND
  • NY, LATHAM
  • OH, COLUMBUS
  • GA, AUGUSTA
  • IA, W DES MOINES
  • MA, WOBURN
  • MA, NEWTON 55 CHAPEL ST

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Description

Wound Care UM RN  

Location:  Remote, within 50 miles of a pulse point

Hours:  An 8 hour shift Monday - Friday between the hours of 8 am - 7 pm CST.

A proud member of the Elevance Health family of companies, Carelon Post Acute Solutions, formerly myNEXUS, is the leader in health resource optimization, focused on transforming how healthcare is delivered and promoting the advancement of care for the people we serve. The Wound Care UM RN is responsible for performing pre-certification certification and/or authorization activities for Home Health Services for members with wound care needs included as contracted services that meet eligibility and benefits coverage. You will oversee members who have complex wound needs to determine if the member has the  appropriate wound care for the type of wound, and identify and monitor delivery of home-based services,  respond to members total health needs and ensures the highest quality of continuity of care.

How you will make an impact:   

  • Develops coordinated  collaborative care plans with all involved providers.
  • Reviews Home based services for clinical appropriateness of the continued care.
  • Performs reviews telephonically using the members medical records  discussion with the members physician and/or discussion with Home health agency staff.
  • Contacts the home care agency and ordering physician to discuss changing the member plan of care for wound care.
  • Promotes healing and decrease home care utilization.
  • Responsible for certification determinations and sending written authorizations to referring physician and home health care provider.
  • Requests additional clinical information from members care providers as necessary.
  • Facilitates timely discharges and transfers based on individual needs and care requirements.
  • Educates patients to help them understand their health choices and assists them in making informed decisions about their health care.
  • Serves as an information resource to patients  health care professionals  facilities  health plan representatives  care givers and family members.
  • Monitors cost-effective use of resources and uses clinical expertise to make recommendations for alternate resources as needed.
  • Refers requests that do not meet coverage guidelines criteria to Physician for review.
  • Uses clinical judgment in authorizations that fall outside of guideline parameters.

Minimum Requirements:   

  • Requires RN license and minimum of 5 years of experience in a variety of health care settings; or any combination of education and experience  which provides an equivalent background.
  • Current  active  unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States required.
  • Certifications relevant to wound care  such as WOCN or CWS required.

Preferred Skills, Capabilities and Experiences:  

  • Home health experience preferred.
  • 1 year of Utilization Management experience preferred.
  • Multi-State/Compact Nursing License strongly preferred.
  • CA and NY RN License is strongly preferred.

** For candidates working in person or remotely in the below locations, the salary* range for this specific position is $34.54 to $62.17

Locations:  California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company.  The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. 

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.


 

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.

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