CVS Health
Utilization Management Nurse Consultant NICU Must be RN Licensed in TX
CVS Health, Austin, Texas, us, 78716
Utilization Management Nurse Consultant NICU – RN Licensed in TX
Join CVS Health as a Utilization Management Nurse Consultant specializing in the Neonatal Intensive Care Unit (NICU). This full‑time role supports high‑quality, cost‑effective care by reviewing, assessing and coordinating NICU cases.
Position Summary Schedule: 8:00‑5:00 PM CST, rotating weekends. Work Monday‑Friday 8 AM‑5 PM CST with occasional weekend/holiday on‑call.
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.
Apply strong critical thinking, communication, and organizational skills.
Proficiency with electronic medical records and utilization review systems.
Required Qualifications
Active, current, and unrestricted RN licensure in TX.
Minimum 5 years of recent NICU nursing experience.
Willingness and ability to work Monday‑Friday 8 AM‑5 PM CST with occasional weekend/holiday on‑call.
Proficiency with computer skills, including 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 Associate’s degree required. BSN preferred.
Work Details Anticipated weekly hours: 40
Time type: Full time
Pay range: $29.10 – $62.32 per hour
Additional compensation may include bonus, commission, or short‑term incentive programs.
Benefits
Affordable medical plan options, 401(k) plan (with matching contributions), and employee stock purchase plan.
No‑cost programs such as wellness screenings, tobacco cessation, weight management, confidential counseling, and financial coaching.
Benefit solutions for paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access, and more depending on eligibility.
Our pay and benefits support your physical, emotional, and financial wellness.
This position is eligible for benefits in accordance with the EEO statement. Qualified applicants with arrest or conviction records will be considered for employment in compliance with all federal, state, and local laws.
#J-18808-Ljbffr
Position Summary Schedule: 8:00‑5:00 PM CST, rotating weekends. Work Monday‑Friday 8 AM‑5 PM CST with occasional weekend/holiday on‑call.
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.
Apply strong critical thinking, communication, and organizational skills.
Proficiency with electronic medical records and utilization review systems.
Required Qualifications
Active, current, and unrestricted RN licensure in TX.
Minimum 5 years of recent NICU nursing experience.
Willingness and ability to work Monday‑Friday 8 AM‑5 PM CST with occasional weekend/holiday on‑call.
Proficiency with computer skills, including 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 Associate’s degree required. BSN preferred.
Work Details Anticipated weekly hours: 40
Time type: Full time
Pay range: $29.10 – $62.32 per hour
Additional compensation may include bonus, commission, or short‑term incentive programs.
Benefits
Affordable medical plan options, 401(k) plan (with matching contributions), and employee stock purchase plan.
No‑cost programs such as wellness screenings, tobacco cessation, weight management, confidential counseling, and financial coaching.
Benefit solutions for paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access, and more depending on eligibility.
Our pay and benefits support your physical, emotional, and financial wellness.
This position is eligible for benefits in accordance with the EEO statement. Qualified applicants with arrest or conviction records will be considered for employment in compliance with all federal, state, and local laws.
#J-18808-Ljbffr