Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care.
G.E.H.A has one mission: To empower federal workers to be healthy and well.
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 G.E.H.A's emerging health trends to recommend targeted improvements that support divisional and organizational objectives.
SKILLS
Duties and Responsibilities:
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.
Knowledge, Skills, and Abilities:
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.
Work-at-home requirements
Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office.
A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required.
Latency (ping) response time lower than 80 ms
Hotspots, satellite and wireless internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
How we value you
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
While this is a remote opportunity, at this time G.E.H.A does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, Maine.
Please note that the salary information is a general guideline only. G.E.H.A considers factors such as (but not limited to) scope and responsibilities of the position, candidate's work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer.
The target hiring range for this position is $75,025 - $94,912 USD. At G.E.H.A, the current maximum salary for this role is $105,759 USD. While initial compensation may vary based on experience and qualifications, there is a path to work toward this top rate through performance and continued growth within the organization.
G.E.H.A is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. G.E.H.A will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees.
G.E.H.A is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.
Please note: Due to recent fraudulent activity in the job market, if you receive correspondence from someone at G.E.H.A, we recommend you review the following facts to help verify if someone is truly a G.E.H.A employee before sharing any personal information.
All email addresses of G.E.H.A employees will end with our domain, @ geha.com . Any other domain is not verified and is illegitimate. Please double check the spelling as well .
We will never extend a job offer without having at least one live video call.
We will never ask you for or provide you with any money, personal or banking information during the interview process or before signing an offer letter.
Please report any suspicious messages to HumanResources@geha.com so that we can help reduce this fraudulent activity.
Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care.
G.E.H.A has one mission: To empower federal workers to be healthy and well.
Your FUTURE is here with us -COME GROW WITH G.E.H.A!
Benefits start on day one! Great 401(k) match! Tuition assistance programs! Professional development! Advancement opportunities!
For additional information, please visit GEHA Careers (https://www.geha.com/careers) .
