GEHA Health

Nurse Consultant II

Remote, USA · Mid

Sponsorship not specified$75k-$95kDetected 69 days ago

ReactComplianceHIPAACommunication

About the role

Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care.
The role 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.
Please note that the salary information is a general guideline only.

Leverages a spectrum of hard and soft skills to collaborate with others across the service continuum to address member and provider daily and escalated needs.
Performs in-depth and root cause analysis to identify barriers to care or member/provider experience.
Serving as a clinical advocate and liaison across departments and external partners, the Nurse Consultant II uses multiple systems to inform decisions, communicate effectively, and document care.

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.

Clinical proficiency and expertise pertinent to role.
Case Management or Utilization Management experience.
Relevant certifications in case management or utilization management.
Work-at-home requirements
A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required.
Latency (ping) response time lower than 80 ms
Hotspots, satellite and wireless internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Duties and Responsibilities:
Refers member and providers to G.E.H.A resources and programs, as indicated.
Encourages members to participate in their health care decisions and assists members with researching treatment options.
Proactively identifies potential barriers, proposes and implements solutions.
Maintains a clear understanding of Plan Benefits.
Monitors and evaluates program effectiveness, tracks relevant metrics, and reports outcomes.
Knowledge, Skills, and Abilities:
BSN and 4-6 years of relevant experience.

Evaluates member health metrics and professional resources to inform, develop, select, implement, and sustain targeted UM/CM initiatives and programs.
Health plan and/or payor experience along with appeals experience is preferred.
Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office.
Health/Vision/Dental benefits effective day one

This listing is sourced directly from GEHA Health's careers page and normalized into a canonical job model.