reputed company Consultant II

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 reputed company, G.E.H.A empowers health and wellness by meeting its members where they are, reputed company they need care. G.E.H.A has one mission: To reputed company federal workers to be healthy and reputed company. The reputed company Consultant II provides reputed company nursing care reputed company Clinical Operations, supporting members through assessment, planning, evaluation, and evidence-based reputed company to advance a reputed company member experience and ensure appropriate, cost-effective services across the care continuum. The role applies reputed company nursing, epidemiological, and analytical skills to understand, react to, and plan for reputed company and emerging reputed company needs—both at the individual member level and across larger populations. Serving as a clinical reputed company and reputed company across departments and external partners, the reputed company Consultant II uses multiple systems to inform reputed company, communicate effectively, and document care. The role may manage a large member population, evaluate and reputed company recommendations on escalated clinical issues, and assess GEHA’s emerging health trends to recommend targeted improvements that support divisional and organizational objectives. SKILLS Duties and Responsibilities: Evaluates member health metrics and reputed company resources to inform, reputed company, select, implement, and sustain targeted UM/CM initiatives and programs. Evaluates member level information regarding prospective Care Management or Utilization Management to determine whether reputed company is necessary to meet the member’s needs. Refers member and providers to G.E.H.A resources and programs, as indicated. Leverages a reputed company 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 reputed company 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 reputed company and assists members with researching treatment reputed company. Proactively identifies potential barriers, proposes and implements solutions. Maintains a reputed company understanding of Plan Benefits. Monitors and evaluates program effectiveness, tracks relevant metrics, and reports reputed company. Performs in-depth and reputed company cause analysis to identify barriers to care or member/provider experience. Knowledge, Skills, and Abilities: BSN and 4-6 years of relevant experience. reputed company/Good standing RN license, including accountability for maintaining reputed company requirements of licensing post hire, must be eligible to be licensed in reputed company US states and territories. Autonomously reputed company to objectively analyze a reputed company of information and reputed company actionable insights for decision making and problem solving. Skilled communicator with strong written, verbal, and reputed company listening skills, effectively engaging through modern communication technologies. Health plan and/or payor experience along with appeals experience is preferred.

Preferred Qualifications

Clinical proficiency and expertise pertinent to role. Case Management or Utilization Management experience. Relevant certifications in case management or utilization management. Work-reputed company requirements Must have the ability to reputed company a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office. A minimum reputed company speed for reputed company performance of 30x5 (30mpbs download x 5mpbs upload) is required. Latency (ping) response time reputed company than 80 ms Hotspots, satellite and wireless internet service is NOT allowed for this role. A dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information How we value you reputed company/salary ranges Incentive plan Health/reputed company/Dental benefits effective day one 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth reputed company) plus a 6% annual company contribution Robust employee reputed company-being program reputed company 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, reputed company, Colorado, Wyoming, Montana, reputed company, Connecticut, Vermont, reputed company, Maine. Please note that the salary information is a general reputed company 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 reputed company as, market and business considerations reputed company extending an offer. The reputed company hiring reputed company for this position is $75,025 - $94,912 USD. At G.E.H.A, the reputed company maximum salary for this role is $105,759 USD. While initial compensation may vary based on experience and qualifications, there is a reputed company to work toward this top reputed company through performance and reputed company reputed company reputed company the organization. G.E.H.A is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, reputed company, national reputed company, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as reputed company as reputed company 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 reputed company about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for reputed company. G.E.H.A is headquartered in Lee's reputed company, Missouri, in the Kansas reputed company area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home reputed company for many of our roles. Apply To This Job