Utilization Management Nurse Consultant – Illinois RN License Required
Join CVS Health’s world‑of‑health team where dedicated colleagues transform health care for millions of Americans.
Position Summary
Must hold a valid Illinois RN license.
Work schedule: Monday‑Friday, 8:00 AM‑5:00 PM CST.
Responsibilities
Utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
Apply critical thinking and evidence‑based care to determine medical necessity and appropriate utilization of services.
Consult with internal and external stakeholders to support the coordination and administration of the utilization/benefit management function.
Gather clinical information and apply appropriate medical necessity criteria, policy and procedure to render coverage determinations, recommendations and discharge planning along the continuum of care.
Collaborate to evaluate and facilitate appropriate healthcare services/benefits for members, including urgent or emergent interventions (e.g., triage/crisis support).
Coordinate and communicate with providers and other parties to facilitate optimal care and treatment.
Identify members who may benefit from care management programs and facilitate referrals.
Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization.
Required Qualifications
Active, current, unrestricted RN licensure in the state of Illinois.
Available to work Monday‑Friday, 8:00 AM‑5:00 PM CST.
Willingness to obtain additional state licenses.
3+ years of clinical practice experience in an inpatient setting as an RN.
Preferred Qualifications
Managed care experience.
Discharge planning experience.
Utilization Management experience.
Education
ASN required; BSN preferred.
Pay Range
The typical hourly base rate for this role is \$32.01‑\$68.55. The actual offer will depend on experience, education, geography and other relevant factors.
Includes eligibility for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay.
Benefitsh3>
Comprehensive and competitive mix of pay and benefits including: affordable medical plan options, 401(k) plan with company match, employee stock purchase plan, wellness programs, financial coaching, flexible work schedules, paid time off, family leave and tuition assistance.
Location
Springfield, IL
Application Closing Date
Application window closes on 11/15/2025.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.