Nurse Consultant II

GEHA Health

Nurse Consultant II role providing professional nursing care within Clinical Operations for G.E.H.A. Supporting members through assessment and evaluation to ensure appropriate healthcare services.

Posted 5/20/2026full-timeRemote • California, Colorado, Connecticut, Maine, Montana, New York, Oregon, Pennsylvania, Vermont, Washington, Wyoming • 🇺🇸 United StatesMid-LevelSenior💰 $75,025 - $94,912 per yearWebsite

Tech Stack

Tools & technologies

React

About the role

Key responsibilities & impact

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.
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.
Serves as a clinical advocate and liaison across departments and external partners.
Uses multiple systems to inform decisions, communicate effectively, and document care.
Manages a large member population, evaluates and makes recommendations on escalated clinical issues, and assesses G.E.H.A’s emerging health trends to recommend targeted improvements that support divisional and organizational objectives.

Requirements

What you’ll need

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.

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

nursing careepidemiological skillsanalytical skillsclinical advocacycase managementutilization managementmedical necessity appealsevidence-based practicepopulation health managementdecision making

Soft Skills

communication skillsactive listeningproblem solvingobjectivityengagementcollaborationrecommendation skillsevaluation skillsplanning skillsinterpersonal skills

Certifications

RN licensecase management certificationutilization management certification