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Utilization Management Nurse Reviewer - Wound Care

Miramar, FL · Healthcare

Our client is an integrated homecare service provider focused on meeting the needs of Health Plans by serving their members through a single source solution. We engage in risk based (e.g. capitation, shared savings) deals with health plans and other risk bearing groups to provide home health, DME, and home infusion services at low cost and high quality. Our delivery model has served over one million health plan members nationwide, contributing to higher star rankings and lower healthcare costs.
We are looking for several experienced and motivated Wound Care Nurses to join our team of Utilization Review professionals.  The WOC Nurse will monitor and authorize home care services for complex wound case.  As part of our team, you assess wounds incurred through accidents and surgical procedures to determine both immediate treatment needs and long-term treatment plans.  You will ensure that the agencies are delivering reasonable and necessary services.
The WOC Nurse will review pre-authorizations for skilled nursing visits of wound care patients. By collaborating with the agency’s coordinator, home care nurse, physician, patient, and caregiver, the UM/WOC Nurse advocates for the delivery of evidence-based treatments and optimization of healthcare resources. Through the WOC Nurse's ongoing management, the organization will improve healthcare outcomes while reducing the costs associated with wound care patients. This unique role for the WOC Nurse in UM provides specialized clinical expertise needed to manage the complex, long-term needs of patients with managed health care plans
You must be a licensed registered nurse (RN) to be considered for this position; bilingual candidates are strongly preferred.
  • Assess the unique needs of each patient to determine appropriate treatment plans
  • Educate patients and families on best practices to promote healing and wellness
  • Track treatments and patient progress according to HIPAA guidelines
  • Coordinate with supervising physicians to ensure smooth recovery processes
  • Fulfill other nursing duties as required
Wound Care Nurse Requirements and Qualifications
  • BSN degree (strongly preferred)
  • Current state licensure as a registered nurse (RN)
  • CPR and basic life support (BLS) certifications
  • Certification and prior experience in wound care
  • Prior experience in inpatient and palliative care (preferred)
Contact information:
Max Populi, LLC
4628 Bayard Street, #207
Pittsburgh, PA 15213-2750
Tel: (412) 567-5279
Fax: (412) 567-5198
e-mail: jobs@maxpopuli.com
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