Hispanic Alliance for Career Enhancement
Utilization Management Nurse Consultant NICU Must be RN Licensed in TX
Hispanic Alliance for Career Enhancement, Granite Heights, Wisconsin, United States
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
Position Summary Schedule for this position is 8:00 - 5:00 PM CST with rotating Weekends.
As a NICU UMNC, you'll leverage your neonatal clinical expertise to review, assess, and coordinate care for neonatal intensive care unit (NICU) cases. You'll ensure medically necessary and cost-effective care by applying clinical guidelines, collaborating with providers, and supporting our commitment to quality outcomes for our youngest patients.
Key Responsibilities
Conduct clinical reviews of NICU requests for medical necessity, appropriateness, and level of care using evidence-based criteria
Collaborate with healthcare providers, case managers, and families to optimize care pathways
Ensure compliance with regulatory and organizational standards
Provide education and support regarding utilization management processes to colleagues and providers
Document clinical determinations and rationales in accordance with policy
Participate in quality improvement initiatives and interdisciplinary meetings as needed
Strong critical thinking, communication, and organizational skills
Proficiency with electronic medical records and utilization review systems
Required Qualifications
Must have active, current and unrestricted RN licensure in TX
5 years of recent NICU nursing experience
Must be willing and able to work Monday - Friday 8 am - 5 pm CST with occasional weekend/holiday on-call
Position requires proficiency with computer skills which includes navigating multiple systems
Ability to work in a fast paced environment
Preferred Qualifications
Certification in Neonatal Intensive Care Nursing (RNC-NIC) or Utilization Review
Prior experience in managed care or health plan setting
Demonstrated ability to work independently and collaboratively
Education Associates degree required BSN preferred
Anticipated Weekly Hours 40
Time Type Full time
Pay Range The typical pay range for this role is: $29.10 - $62.32 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
Affordable medical plan options,
a
401(k) plan
(including matching company contributions), and an
employee stock purchase plan .
No-cost programs for all colleagues
including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues
including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on:
01/18/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
Position Summary Schedule for this position is 8:00 - 5:00 PM CST with rotating Weekends.
As a NICU UMNC, you'll leverage your neonatal clinical expertise to review, assess, and coordinate care for neonatal intensive care unit (NICU) cases. You'll ensure medically necessary and cost-effective care by applying clinical guidelines, collaborating with providers, and supporting our commitment to quality outcomes for our youngest patients.
Key Responsibilities
Conduct clinical reviews of NICU requests for medical necessity, appropriateness, and level of care using evidence-based criteria
Collaborate with healthcare providers, case managers, and families to optimize care pathways
Ensure compliance with regulatory and organizational standards
Provide education and support regarding utilization management processes to colleagues and providers
Document clinical determinations and rationales in accordance with policy
Participate in quality improvement initiatives and interdisciplinary meetings as needed
Strong critical thinking, communication, and organizational skills
Proficiency with electronic medical records and utilization review systems
Required Qualifications
Must have active, current and unrestricted RN licensure in TX
5 years of recent NICU nursing experience
Must be willing and able to work Monday - Friday 8 am - 5 pm CST with occasional weekend/holiday on-call
Position requires proficiency with computer skills which includes navigating multiple systems
Ability to work in a fast paced environment
Preferred Qualifications
Certification in Neonatal Intensive Care Nursing (RNC-NIC) or Utilization Review
Prior experience in managed care or health plan setting
Demonstrated ability to work independently and collaboratively
Education Associates degree required BSN preferred
Anticipated Weekly Hours 40
Time Type Full time
Pay Range The typical pay range for this role is: $29.10 - $62.32 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
Affordable medical plan options,
a
401(k) plan
(including matching company contributions), and an
employee stock purchase plan .
No-cost programs for all colleagues
including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues
including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on:
01/18/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr