Nurse Consultant II

🕒 il y a 15 jours

🏄 California, Colorado, +9 états de plus – Distant

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

💵 $75 025 - $94 912 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

💼 Consultant

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GEHA Health

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 1937

⚕️ Assurance santé

🧘 Bien-être

🏛️ Gouvernement

Healthcare Insurance • Wellness • Government

GEHA Health est une grande association de prestations dédiée à servir les employés fédéraux, les retraités et leurs familles. Fondée par des employés des postes en 1937, GEHA propose une gamme complète de plans de santé et dentaires, incluant des options FEHB et PSHB, ainsi que des avantages supplémentaires tels que des abonnements à des salles de sport, des avantages visuels et des récompenses bien-être. Avec un réseau de 1,7 million de prestataires à l'échelle nationale et une couverture étendue des médicaments sur ordonnance, GEHA privilégie la réinvestissement des bénéfices pour améliorer l'expérience des membres et soutenir la santé de la main-d’œuvre fédérale. Leurs plans comprennent des options Medicare Advantage et une offre robuste de télésanté, garantissant à leurs membres le meilleur soin et couverture possible.

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.

🎯 Exigences

• 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.

🏖️ Avantages

• 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