Nurse Consultant II

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $75k - $94.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

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GEHA Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1937

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

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

• Evaluate member health metrics and professional resources to develop, select, implement, and sustain targeted UM/CM initiatives and programs • Evaluate member-level information to determine whether Care Management or Utilization Management intervention is necessary • Refer members and providers to G.E.H.A. resources and programs • Collaborate across the service continuum to address member and provider daily and escalated needs • Guide, assist, and inform members to maximize health plan benefits • Coordinate services, facilitate access to in-network providers, close gaps in care, and support behavior change • Encourage members to participate in healthcare decisions and research treatment options • Identify potential barriers and implement solutions • Maintain understanding of Plan Benefits • Monitor and evaluate program effectiveness, track metrics, and report outcomes • Perform in-depth and root cause analysis to identify barriers to care or member/provider experience • Serve as a clinical advocate and liaison across departments and external partners • Assess emerging health trends and recommend targeted improvements

🎯 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 • Ability to objectively analyze a variety of information and provide actionable insights for decision making and problem solving • Strong written, verbal, and active listening skills • Clinical proficiency and expertise pertinent to role • Case Management or Utilization Management experience preferred • Relevant certifications in case management or utilization management preferred • Non-cellular high-speed internet service such as Fiber, DSL, or cable Modems for a home office • Minimum internet speed of 30x5 (30mbps download x 5mbps upload) • Latency (ping) response time lower than 80 ms • Hotspots, satellite and wireless internet service are not allowed • Dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Competitive pay/salary ranges • Incentive plan • 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 • Remote and work-from-home options