Nurse Consultant II

This is a fully remote position, open to applicants in California, +10 more states.

📋 Description

• Delivers expert nursing care within Clinical Operations, aiding members through assessment, planning, evaluation, and evidence-based practices to enhance a positive member experience while ensuring appropriate and cost-effective services throughout the care continuum.

• Utilizes professional nursing, epidemiological, and analytical abilities to comprehend, respond to, and strategize for current and future healthcare needs—both on an individual member basis and across broader populations.

• Acts as a clinical advocate and liaison among various departments and external partners.

• Employs diverse systems to guide decisions, communicate effectively, and document care.

• Oversees a large member population, assesses and provides recommendations on escalated clinical matters, and evaluates G.E.H.A’s emerging health trends to suggest targeted enhancements that align with divisional and organizational goals.

⛳️ Requirements

• Bachelor of Science in Nursing (BSN) with 4-6 years of pertinent experience.

• Active, good standing RN license, with accountability for fulfilling all licensing requirements post-hire; must be eligible for licensure in all US states and territories.

• Capable of independently analyzing various information objectively and offering actionable insights for decision-making and problem-solving.

• Proficient communicator with strong written, verbal, and active listening abilities, effectively engaging through contemporary communication technologies.

• Experience in reviewing complex medical necessity appeals.

• Preferred qualifications include clinical proficiency and expertise relevant to the role.

• Experience in Case Management or Utilization Management.

• Relevant certifications in case management or utilization management.

• Experience with utilization management F.E.H.B. payor appeals.

🏝️ Benefits

• Health, Vision, and Dental benefits effective from day one.

• 401(k) retirement plan with company match—dollar for dollar up to 4% employee contribution (available in 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 Accidental Death & Dismemberment (AD&D) insurance.

• Company-provided Short-Term and Long-Term Disability coverage.

• Tuition Assistance Program.