Clinical Team Lead – Utilization Management (RN)

4062 Aetna Resources, LLC; Illinois; Hybrid; USD 67,000 - 143,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Clinical Team Lead in Utilization Management to leverage RN experience in adult acute/critical care. The role coordinates care, reviews cases, and determines coverage using clinical criteria to ensure appropriate benefits.

Typical 40-hour week in an office setting with potential weekends/evenings. Strong communication, collaboration across teams, and proficiency with multiple systems are essential for success.

Qualifications

• 3+ years of RN experience in adult acute/critical care.
• Active, unrestricted RN licensure in state of residence.
• Utilization Management is 24/7; weekends/holidays/evenings required.

Responsibilities

• Analyze reports for assignments, trends, and metrics.
• Serve as first point of contact for frontline staff questions on cases.
• Proctor RN/MD rounds as needed.
• Assist with escalated case reviews and facility issues.
• Gather clinical information and apply guidelines to render coverage decisions.
• Communicate with providers to facilitate care and treatment.
• Identify referral opportunities to integrate with other programs.
• Promote quality and efficiency in healthcare services and benefit utilization.
• Lend clinical expertise to internal and external stakeholders.

Skills

RN experience

Acute/CCU

Clinical assessment

Education

BSN or equivalent

Job description

CVS Health is seeking a Clinical Team Lead in Utilization Management to leverage RN experience in adult acute/critical care. The role coordinates care, reviews cases, and determines coverage using clinical criteria to ensure appropriate benefits.

Typical 40-hour week in an office setting with potential weekends/evenings. Strong communication, collaboration across teams, and proficiency with multiple systems are essential for success.