Nurse Consultant II

📋 Description

• Assesses member health metrics and professional resources to inform, develop, select, implement, and sustain focused UM/CM initiatives and programs.

• Analyzes member-level information related to potential Care Management or Utilization Management to determine if intervention is required to meet the member’s needs.

• Directs members and providers to G.E.H.A resources and programs as necessary.

• Utilizes a range of hard and soft skills to collaborate with others throughout the service continuum to address both daily and escalated needs of members and providers.

• Employs effective engagement techniques to guide, assist, and inform members appropriately, optimizing their health plan benefits, which includes coordinating services, accessing in-network providers, closing care gaps, and modifying health behaviors.

• Motivates members to engage in their healthcare choices and aids them in researching treatment alternatives.

• Proactively recognizes potential obstacles, recommends, and implements solutions.

• Maintains a thorough understanding of Plan Benefits.

• Evaluates and monitors program effectiveness, tracks relevant metrics, and reports outcomes.

• Conducts comprehensive root cause analysis to pinpoint barriers to care or member/provider experiences.

⛳️ Requirements

• BSN with 4-6 years of relevant experience.

• Active/Good standing RN license, with responsibility for maintaining all licensing requirements post-hire, and must be eligible for licensing in all US states and territories.

• Preferred experience in health plans and/or payors, along with appeals experience.

• Clinical proficiency and expertise relevant to the role.

• Experience in Case Management or Utilization Management.

• Relevant certifications in case management or utilization management.

• Must possess the capability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office. A minimum standard speed of 30x5 (30mbps download x 5mbps upload) is required for optimal performance.

🏝️ Benefits

• Health/Vision/Dental benefits effective from 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.

• Comprehensive 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.