Nurse Consultant II

This is a fully remote position, open to applicants in United States.

📋 Description

• Assess member health metrics and professional resources to design, select, implement, and sustain focused UM/CM initiatives and programs.

• Analyze member-level information to ascertain the necessity for Care Management or Utilization Management intervention.

• Direct members and providers to G.E.H.A. resources and programs.

• Collaborate throughout the service continuum to meet both member and provider daily and escalated needs.

• Guide, assist, and inform members to optimize their health plan benefits.

• Coordinate services, enable access to in-network providers, address care gaps, and promote behavior changes.

• Motivate members to engage in healthcare decisions and explore treatment options.

• Identify potential obstacles and implement effective solutions.

• Maintain a comprehensive understanding of Plan Benefits.

• Monitor and assess program effectiveness, track metrics, and report outcomes.

• Conduct in-depth and root cause analyses to uncover barriers to care or member/provider experiences.

• Act as a clinical advocate and liaison across departments and with external partners.

• Evaluate emerging health trends and suggest targeted enhancements.

⛳️ Requirements

• BSN with 4-6 years of relevant experience.

• Active/Good standing RN license, responsible for maintaining all licensing requirements post-hire.

• Must be eligible for licensing in all US states and territories.

• Ability to objectively analyze various types of information and provide actionable insights for decision-making and problem-solving.

• Excellent written, verbal, and active listening skills.

• Clinical proficiency and expertise relevant to the role.

• Experience in Case Management or Utilization Management is preferred.

• Relevant certifications in case management or utilization management are preferred.

• Non-cellular high-speed internet service, such as Fiber, DSL, or cable modems, is required for a home office.

• Minimum internet speed of 30x5 (30mbps download x 5mbps upload).

• Latency (ping) response time must be below 80 ms.

• Hotspots, satellite, and wireless internet services are not permitted.

• A dedicated workspace free from ongoing interruptions to safeguard member PHI/HIPAA information.

🏝️ Benefits

• Competitive pay/salary ranges.

• Incentive plan.

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

• 401(k) retirement plan with company match – dollar for dollar up to 4% employee contribution (both pretax and 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 insurance.

• Company-provided Short-Term & Long-Term Disability insurance.

• Tuition Assistance Program.

• Options for remote and work-from-home arrangements.