Wound Care Nurse (Virtual)
Job Closed
Company
A technology-driven, care and benefit management service that enables individuals to live healthier lives in their homes. Our proven clinical model connects individuals to intelligent care delivering independence at lower costs.
Overview
Top reasons to love this job – 1. Work remotely from home - ideally located in the PT or MT time zones 2. Opportunity to work for a technology-driven care management company 3. Be a member of a progressive and community-minded organization Top "must-have" skills for this job – 1. Active WOCN certification is required 2. 5 years+ experience in healthcare setting; home health required 3. Current RN license Perform 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. Case Manage members who have complex wound needs to determine if the member has the current wound care for the type of wound. Contact the home care agency and ordering physician to discuss changing the member plan of care for wound care. Promote healing and decrease home care utilization. Responsible for certification determinations and sending written authorizations to referring physician and home health care provider. When necessary, requests additional clinical information from member’s care providers. Refers requests that do not meet coverage guidelines criteria to Physician Review for a Level III Review. The case management component of the UM program is designed to identify and monitor delivery of home based services in an efficient manner, responding to a member’s total health needs and ensure the highest quality of continuity of care. Develop coordinated, collaborative care plans with all involved providers. Review Home based services for clinical appropriateness of the continued care. Performs reviews telephonically using the member’s medical records, discussion with the member’s physician and/or discussion with Home health agency staff. Facilitate timely discharges and transfers based on individual needs and care requirements. Educate patients to help them understand their health choices and assist them in making informed decisions about their health care. Serve as information resource to patients, health care professionals, facilities, health plan representatives, care givers and family members. Monitor cost-effective use of resources.