Nurse Consultant II
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Job Description
Nurse Consultant II role providing professional nursing care within Clinical Operations for G.E.H.A. Supporting members through assessment and evaluation to ensure appropriate healthcare services.
Responsibilities:
- 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
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