Nurse Consultant II-Oncology

GEHA, Inc.

job description

Position Title: Nurse Consultant II - Oncology

Open Positions: 1

Posted Date: July 30, 2021

Location: Lee’s Summit, MO (200 Building)

Department: Population Management

Supervisor: Shelley Hayes

Apply online at: https://geha.wd5.myworkdayjobs.com/en-US/GEHACareers/job/Lees-Summit-200/Nurse-Consultant-II---Oncology_R-002941

Summary Performs essential functions of care management for identified and assigned member population according to HIPAA guidelines. Manages a specified caseload; coordinating health care benefits, providing education and facilitating member access to care in a timely and cost-effective manner. Collaborates and communicates with member, family, and health team to promote wellness and member autonomy, while ensuring access to appropriate services across the healthcare continuum and maximizing member benefits. Serves as clinical advocate for members and liaison with other departments and external health care team. Uses claims processing and care management software to look up member information, document contacts, and track member progress. Functions as a peer leader in the Care Management Career Ladder program.

The Nurse Consultant II provides professional nursing care to our members through the execution of key duties within the discipline of the Clinical Operations division. Incumbents at level II support members through assessment, evaluation, planning, and evidence-based research that promotes optimum health care and service delivery.

Key responsibilities may include assessment of open gaps in care, education of the member on how to close those gaps, review of clinical history, and review of member's treatment plan against evidence-based medicine. Incumbents must possess the ability to actively engage and influence the member to modify behaviors and health care decisions in support of improved health through direct member contact and/or clinical and/or plan policy development and management. Works as a subject matter expert who is involved in research and development of policies. Driven in decision making and works independently. Uses clinical judgement when guidelines are not established. In some cases, this may require coordination with key external vendors. Additionally, collaboration and communication with the member’s family and health team is often necessary to promote evidence-based medicine and wellness. The coordination of health care benefits, providing education, and facilitating member access to care in a timely and cost effective manner.

The incumbents will ensure access to appropriate services across the healthcare continuum and maximize member benefits. They will serve as a clinical advocate for members and liaison within the division, among other departments and external health care teams. Use of systems to retrieve member information, document contacts, track member progress, and research evidence-based practice is required. Nurse Consultant II may manage a large assigned member population, provide ongoing guidance and delegate appropriate tasks. Provides full principles of education and ongoing guidance necessary to implement policies and processes necessary to division operations and decision making. Works with internal and external vendor partners across programs on internal processes and clinical reviews.

Duties

• Evaluates information regarding prospective Care Management (CM)/ Medical Management (MM) to determine whether intervention is necessary to meet the member’s needs.

• Refer to internal GEHA programs as indicated.

Government Employees Health Association, Inc.

OPEN POSITION

• May manage a participant caseload, to ensure that turnaround time and backlog are within team performance targets.

• Reviews member claims history and identifies opportunities. Initiates CM/MM services for members if applicable.

• Provides direction and assistance to clinical support team regarding benefit approvals and denials. Notifies Cost Utilization Specialist (CUS) of participants needs including the need for special education, reminder calls, satisfaction survey, incentives, or any additional service needs according to specific program guidance

• Works across the department coordinating tasks with departmental teams as needed to complete tasks or meet member needs

• Collaborates with the GEHA Medical Director regarding complex benefit decisions, appropriateness of care, and medical necessity reviews per policies

• Collaborates with primary care physicians and other treating professionals to determine medical necessity as appropriate.

• Educates members about accessing services, in -network use, and evidence-based guidelines.

• Process benefit determinations according to company policies.

• Takes accountability for obtaining and maintaining all professional licenses. Including CEUs and other trainings.

• Facilitates appropriate use of resources and coordinates necessary services to improve health status and impact the cost of care.

• Monitors and evaluates member progress toward gap closure and alters course as indicated.

• Employs engagement techniques to build relationships with members.

• Encourages members to participate in their health care decisions and assists members with researching treatment options.

• Critically thinks to solve problems.

• Proactively identifies potential barriers for members and helps steer them to positive health outcomes.

• Reviews member claims history and identifies interventions/service opportunities /appropriate care coordination.

• Gathers data and information from various reliable sources to recommend and create desk level policies and workflows for process improvement and role clarification.

• Uses learning theories to develop curriculum and deliver content.

Education Requirements

Requires a Bachelor’s degree, current RN license in good standing in state of residence and must be eligible for licensure in all 50 US states. Additional years of qualifying work experience may be considered in lieu of Bachelor’s degree.

Experience Requirements

• Requires 2 years of experience working with oncology providers and patients, administering chemotherapy, knowledge of chemotherapy treatments, and radiation therapy.

• Oncology Certified Nurse (OCN)

• Requires the ability to use a personal computer and knowledge of medical information systems.

Preferred

Case management experience

GEHA is an Equal Opportunity Employer. GEHA 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. Our company's corporate headquarters is located in Lee's Summit near Douglas Rd and I-470 with a total of five locations in the Kansas City metropolitan area.

contact information

business: GEHA, Inc.
address: 200 NE Mulberry Street
Lee's Summit, MO 64086
phone: 816-257-5500 (Call Now)
website: https://geha.wd5.myworkdayjobs.com/GEHACareers

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