CVS Health is an American healthcare company working across healthcare services, health insurance, pharmacy benefits management, and retail pharmacy. Through businesses including Aetna and CVS Caremark, it supports health coverage, prescription access, condition management, specialty medications, and mail-order pharmacy services. Its neighborhood pharmacies and broader care offerings are designed to help people access essential healthcare more conveniently and affordably. CVS Health brings together insurance, pharmacy, and health services to support individuals and communities throughout their care journeys.
Utilization Management Nurse Consultant - Illinois Remote
CVS Health is hiring an Illinois-based remote Utilization Management Nurse Consultant to review clinical information, make coverage recommendations, and coordinate member care. The role requires an active RN license and adult acute-care or critical-care experience.
Description
- Evaluate and coordinate care options that support appropriate healthcare services and member benefits
- Review clinical records and apply established criteria, guidelines, policies, procedures, and professional judgment to make coverage determinations or recommendations
- Coordinate care and treatment by communicating with providers and other relevant parties
- Recognize members who may benefit from referrals to additional products, services, or programs
- Identify ways to improve healthcare quality and promote effective use of benefits
- Provide utilization and benefit management expertise to internal and external stakeholders
- Work in a standard office setting while meeting productivity and quality expectations
- Closely review handwritten materials, computer-generated documents, and monitor displays
- Remain seated for extended periods while using the telephone and computer
- Manage multiple priorities and adjust effectively in a fast-changing, high-volume environment
Requirements
- At least two years of clinical experience as a Registered Nurse in an adult acute-care or critical-care hospital setting
- Current, active, unrestricted RN license in the state where you reside
- Availability to work weekends, holidays, and evening shifts in a 24/7 operation
- Proficiency using computers, navigating multiple systems, and keyboarding
- Strong verbal and written communication skills
- A direct wired internet connection to a modem or router located within seven feet of the computer
- Internet service providing at least 25 Mbps download and 3 Mbps upload speeds
- Wi-Fi and satellite internet connections are not permitted
- A quiet, secure, private home workspace that complies with CVS Health and HIPAA requirements
- Work from the state and city where you currently live
- Ability to provide suitable workspace furniture, such as a desk or standing desk
- Ability to meet required internet speeds and comply with work-from-home requirements
- Comfort setting up and using multiple monitors and working across several applications at once
- Ability to use email, calendar invitations, Teams messaging, and virtual meeting tools
- Experience with Microsoft Office 365 applications, including Teams, Outlook, Word, Excel, and PowerPoint, or comparable Google Workspace tools
- Ability to access secure systems such as VPN and electronic health record portals
- Ability to maintain strong passwords and identify suspicious emails or links
- Ability to troubleshoot common technical problems independently and contact IT when needed
- Associate or Bachelor of Science in Nursing; BSN preferred
Benefits
- Eligibility for a CVS Health bonus, commission, or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Additional resources supporting physical, emotional, and financial well-being
- Company-provided equipment, including a keyboard, monitor, computer, and headset
- Comprehensive benefits package for eligible full-time employees