[Hiring] Nurse Consultant II @GEHA Health

Role Description

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 healthcare 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 GEHA’s emerging health trends to recommend targeted improvements that support divisional and organizational objectives.

Qualifications

• 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.
• Health plan and/or payor experience along with appeals experience is preferred.

Requirements

• Evaluates member health metrics and professional resources to inform, develop, select, implement, and sustain targeted UM/CM initiatives and programs.
• Evaluates member level information regarding prospective Care Management or Utilization Management to determine whether intervention is necessary to meet the member’s needs.
• Refers member and providers to G.E.H.A resources and programs, as indicated.
• 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.
• Using effective engagement techniques, guides, assists and informs members when appropriate in a manner that maximizes their health plan benefits including but not limited to coordinating services, accessing in-network providers, closing gaps in care and altering health behavior.
• 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.
• Performs in-depth and root cause analysis to identify barriers to care or member/provider experience.

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