Registered Nurse Consultant

Job Summary

Providing professional nursing care in a remote full-time capacity, the Nurse Consultant II will support members through assessment, planning, and evaluation to enhance the member experience and ensure effective healthcare services.

Key responsibilities

• Evaluates member health metrics to develop and implement targeted care management initiatives
• Assesses member needs for potential intervention in Care Management or Utilization Management
• Collaborates with various departments and external partners to address member and provider needs effectively

Required qualifications

• Bachelor of Science in Nursing (BSN) with 4-6 years of relevant experience
• Active RN license in good standing, eligible for licensure in all US states and territories
• Experience in reviewing complex medical necessity appeals
• Ability to analyze information and provide actionable insights for decision-making
• Strong communication skills, proficient in modern communication technologies