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Sign up with Clera and we'll reach out the moment a role actually fits you — no more spraying applications into the void.
$32/hr–$68/hr
Full-time
associate degree, bachelor degree
Medical coverage, Dental coverage, Vision coverage, Paid time off, Retirement savings options, Wellness programs
Posted 8d ago
Apply by Aug 9
~40 hrs/week
Remote in Illinois, United States
Responsibilities
The Utilization Management Nurse Consultant coordinates and documents benefit management programs by applying clinical expertise and medical necessity criteria. They collaborate with providers to facilitate optimal care, identify members for care management, and ensure effective utilization of healthcare services.
Requirements
Candidates must hold an active, unrestricted RN license and possess at least 3 years of inpatient clinical experience. Proficiency in navigating multiple computer systems and a willingness to obtain additional state licenses are also required.
Full job description
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
Utilization Management is a 24/7 operation and work schedule may include weekends, holidays and evening hours.
As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services.
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgement to render coverage determination/recommendation/discharge planning along the continuum of care.
Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage/crisis support).
Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment.
Identifies members who may benefit from care management programs and facilities referrals.
Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
Required Qualifications - Must have active, current, and unrestricted RN licensure in state of residence
Willingness to obtain additional state licenses
3+ years of clinical practice experience in an inpatient setting as an RN
1+ years of experience with computer skills which includes navigating multiple systems and keyboarding
Preferred Qualifications - Knowledge or clinical practice experience in a post acute facility ( Skilled nursing, Rehabilitation, Long Term Acute Care)
-Active IL RN Licensure
Education Associates degree required
BSN preferred
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$32.01 - $68.55
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 08/09/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Related keywords
Utilization ManagementNurse ConsultantRNClinical PracticeInpatientMedical NecessityCare ManagementTriageDischarge PlanningHealthcareBenefit ManagementEvidence-based CarePost-acute CareRehabilitationSkilled NursingLong Term Acute Care
Simplifying health care one person, one family and one community at a time
Industry
Hospitals and Health Care
Company size
10,001+ employees
Founded
1963
Headquarters
Woonsocket, RI
LinkedIn followers
1,242,594
Total funding
$4.0B
CVS Health is the leading health solutions company, delivering care like no one else can. We reach more people and improve the health of communities across America through our local presence, digital channels and over 300,000 dedicated colleagues.
Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by simplifying health care one person, one family and one community at a time. Follow @CVSHealth on social media.
Offices: 1 CVS Drive, Woonsocket, RI 02895, US · 9501 E. Shea Blvd, Scottsdale, AZ 85260, US · 2211 Sanders Road, Northbrook, IL 60062, US · 750 West John Carpenter Freeway, Ste 1200, Irving, TX 75039, US · 620 Epsilon Dr, Pittsburgh, PA 15238, US
RetailPharmacy Benefits ManagementHealth InsuranceHealth CarePharmacyRetailCare Managementand Primary CareFinanceHealth Care
Based on 5020 listings with disclosed salaries, most healthcare jobs in Illinois pay between $67k–$191k per year. Individual offers vary with seniority, company size, and specialization.
How many Healthcare jobs are open in Illinois right now?
There are currently 23,010 open healthcare positions in Illinois listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Healthcare roles in Illinois?
Companies currently hiring include Northwestern Medicine, OSF HealthCare, Nevada System of Higher Education, Allergan, American Addiction Centers, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Healthcare jobs in Illinois?
Yes — 2296 of the 23010 open healthcare positions offer remote or hybrid work (822 remote, 1474 hybrid).
How do I apply for Healthcare jobs in Illinois?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.