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Healthcare Professional with Wound Care Expertise

1 week ago


Los Angeles, California, United States Elevance Health Full time
Role Description:
As a RN - Utilization Manager at Elevance Health, you will be responsible for delivering high-quality patient care by overseeing members with complex wound needs and determining the most effective wound care treatment. This role requires a unique blend of clinical expertise, business acumen, and communication skills. You will work closely with cross-functional teams to ensure that members receive the highest level of care possible. Your responsibilities will include reviewing medical records, discussing cases with physicians and home health agency staff, and making informed decisions regarding certification determinations and written authorizations. In addition to your technical skills, you will need to possess excellent communication and interpersonal skills, as well as the ability to work effectively in a fast-paced environment.

Responsibilities:
- Develop and implement coordinated care plans with involved providers
- Review home-based services for clinical appropriateness and make recommendations for improvement
- Make timely decisions regarding certification determinations and written authorizations
- Oversee members with complex wound needs and determine the most effective wound care treatment
- Communicate effectively with patients, family members, and healthcare professionals
- Stay up-to-date with industry developments and best practices in wound care management

Qualifications:
- Current active valid unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States
- Certifications relevant to wound care such as WOCN or CWS
- Experience in home health or utilization management preferred
- Strong communication and interpersonal skills
- Ability to work effectively in a fast-paced environment

Why Choose Elevance Health?
Elevance Health is a leading healthcare company dedicated to improving lives and communities. We offer a comprehensive benefits package, opportunities for career growth and development, and a positive work environment that promotes collaboration, respect, and open communication. Our associates are passionate about delivering exceptional patient care and making a difference in the lives of our members.