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　　Wound Care UM RN

　　Job Family: Medical and Clinical

　　Type: Full time

　　Date Posted:Jan 18, 2024

　　Anticipated End Date:Feb 29, 2024

　　Reference: JR102348

　　Location:

　　IN, INDIANAPOLIS

　　PA, SEVEN FIELDS

　　VA, ARLINGTON

　　FL, MIAMI

　　MA, BOSTON

　　OH, CINCINNATI

　　NY, NEW YORK

　　CT, ROCKY HILL

　　CA, RANCHO CORDOVA

　　MI, WIXOM

　　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

　　NE, LINCOLN

　　DE, WILMINGTON

　　NE, OMAHA

　　OH, SEVEN HILLS

　　ID, MERIDIAN

　　ID, MERIDIAN

　　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

　　WA, SEATTLE

　　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

　　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:

　　WOCNCB certification preferred.

　　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 [email protected] for assistance.

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　　Elevance Health, Inc. is anE-verify Employer (https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)

　　Need Assistance?

　　Email us ([email protected])