Nurse Consultant II

🕒 May 20

🏄 California, Colorado, +9 more states – Remote

🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🗽 New York – Remote 🌲 Oregon – Remote 🔔 Pennsylvania – Remote 🍁 Vermont – Remote ☕ Washington – Remote 🦬 Wyoming – Remote

💵 $75k - $94.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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GEHA Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1937

⚕️ Healthcare Insurance

🧘 Wellness

🏛️ Government

Healthcare Insurance • Wellness • Government

GEHA Health is a large benefits association dedicated to serving federal employees, retirees, and their families. Founded by postal workers in 1937, GEHA offers a comprehensive range of health and dental plans, including FEHB and PSHB options, as well as additional benefits such as gym memberships, vision benefits, and wellness rewards. With a network of 1. 7 million providers nationwide and extensive prescription drug coverage, GEHA prioritizes reinvesting profits to enhance member experiences and support federal workforce health. Their plans include Medicare Advantage options and a robust telehealth offering, ensuring their members receive the best possible care and coverage.

📋 Description

• Provides professional nursing care within Clinical Operations, supporting members through assessment, planning, evaluation, and evidence-based practice to advance a positive member experience and ensure appropriate, cost-effective services across the care continuum. • Applies professional nursing, epidemiological, and analytical skills to understand, react to, and plan for current and emerging healthcare needs—both at the individual member level and across larger populations. • Serves as a clinical advocate and liaison across departments and external partners. • Uses multiple systems to inform decisions, communicate effectively, and document care. • Manages a large member population, evaluates and makes recommendations on escalated clinical issues, and assesses G.E.H.A’s emerging health trends to recommend targeted improvements that support divisional and organizational objectives.

🎯 Requirements

• BSN and 4-6 years of relevant experience. • Active/Good standing RN license, including accountability for maintaining all requirements of licensing post hire, must be eligible to be licensed in all US states and territories. • Autonomously able to objectively analyze a variety of information and provide actionable insights for decision making and problem solving. • Skilled communicator with strong written, verbal, and active listening skills, effectively engaging through modern communication technologies. • Experience reviewing complex medical necessity appeals. • Preferred Qualifications Clinical proficiency and expertise pertinent to role. • Case Management or Utilization Management experience. • Relevant certifications in case management or utilization management. • Experience in utilization management F.E.H.B. payor appeals.

🏖️ Benefits

• Health/Vision/Dental benefits effective day one • 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution • Robust employee well-being program • Paid Time Off • Personal Community Enrichment Time • Company-provided Basic Life and AD&D • Company-provided Short-Term & Long-Term Disability • Tuition Assistance Program