Clinical Team Lead, Utilization Management (RN)

CVS Health Corporation; Springfield (IL); On-site; USD 67,000 - 143,000; Full time

Job summary

CVS Health Corporation is seeking a Clinical Team Lead in Utilization Management to assess, plan, implement, coordinate, monitor and evaluate options for appropriate healthcare services for members.

The role requires 3+ years as an RN in adult acute/critical care, active RN license, and a 24/7 schedule including weekends/evenings. BSN/ADN preferred; managed care experience is a plus. Full-time role with comprehensive benefits.

Qualifications

• 3+ years of experience as a Registered Nurse in adult acute care/critical care.
• Active current and unrestricted RN licensure in state of residence.
• Utilization Management is a 24/7 operation; weekends, holidays, and evening hours.

Responsibilities

• Analyzes reports for assignments/trends/metrics/issues.
• First in line for questions from frontline staff on cases.
• May proctor RN/MD rounds.
• Assists with escalated case reviews/facility issues.
• Gathers clinical information and applies guidelines to render coverage decisions.
• Communicates with providers to facilitate care and identify referral opportunities.
• Identifies opportunities to promote quality and effectiveness of Healthcare Services and benefit utilization.
• Consults with internal and external constituents in the utilization/benefit management function.
• Work in a typical office environment with productivity and quality expectations.

Skills

RN licensure

Clinical assessment

Critical care experience

Communication skills

Team collaboration

Education

Associate or Bachelor of Science in Nursing (BSN/ADN)

Job description

CVS Health Corporation is seeking a Clinical Team Lead in Utilization Management to assess, plan, implement, coordinate, monitor and evaluate options for appropriate healthcare services for members.

The role requires 3+ years as an RN in adult acute/critical care, active RN license, and a 24/7 schedule including weekends/evenings. BSN/ADN preferred; managed care experience is a plus. Full-time role with comprehensive benefits.