Nurse Consultant II

Job Overview The Nurse Consultant II 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. The role applies professional nursing, epidemiological, and analytical skills to understand, react to, and plan for current and emerging health‑care needs—both at the individual member level and across larger populations. 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. The role may manage a large member population, evaluate and make recommendations on escalated clinical issues, and assess G.E.H.A’s emerging health trends to recommend targeted improvements that support divisional and organizational objectives. Responsibilities Evaluate member health metrics and professional resources to inform, develop, select, implement, and sustain targeted UM/CM initiatives and programs. Evaluate member‑level information regarding prospective Care Management or Utilization Management to determine whether intervention is necessary to meet the member’s needs. Refer member and providers to G.E.H.A resources and programs, as indicated. Collaborate with others across the service continuum to address member and provider daily and escalated needs. Use effective engagement techniques to guide, assist, and inform members to maximize their health plan benefits, including coordinating services, accessing in‑network providers, closing gaps in care, and altering health behavior. Encourage members to participate in their health‑care decisions and assist them with researching treatment options. Proactively identify potential barriers, propose and implement solutions. Maintain a clear understanding of Plan Benefits. Monitor and evaluate program effectiveness, track relevant metrics, and report outcomes. Perform in‑depth and root‑cause analysis to identify barriers to care or member/provider experience. Qualifications and Experience BSN and 4–6 years of relevant experience. Active/Good standing RN license, including accountability for maintaining all requirements of licensing post‑hire; eligible to be licensed in all U.S. 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: Clinical proficiency and expertise pertinent to the role; case management or utilization management experience; relevant certifications in case management or utilization management; experience in utilization management FEHB payer appeals. Remote Work Requirements Provide non‑cellular high‑speed internet (fiber, DSL, or cable modems) with a minimum download speed of 30Mbps and upload speed of 5Mbps. Latency (ping) response time lower than 80ms; hotspots, satellite, and wireless internet are not allowed. Dedicated workspace with no ongoing interruptions to protect member PHI/HIPAA information. Compensation and Benefits Target hiring range: $75,025–$94,912USD; maximum salary $105,759USD. Competitive pay/salary and incentive plan. Health/Vision/Dental benefits effective day one. 401(k) retirement plan: company match dollar for dollar up to 4% employee contribution plus 6% annual company contribution. Robust employee well‑being program. Paid Time Off. Personal Community Enrichment Time. Company‑provided basic life and AD&D insurance. Company‑provided short‑term & long‑term disability. Tuition assistance program. Eligibility This remote opportunity does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, NewYork, Connecticut, Vermont, Pennsylvania, Maine. Equal Opportunity Employer Statement GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees. #J-18808-Ljbffr GEHA