Remote RN Lead, Utilization Management

CVS Health Corporation; Northern (KY); Hybrid; USD 67,000 - 143,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health Corporation is seeking a Clinical Team Lead in Utilization Management for a remote role. You will analyze utilization data, support frontline staff on cases, and coordinate reviews to ensure appropriate healthcare services for members.

The position requires strong clinical judgment and communication across providers and teams. The role offers a comprehensive benefits package, a base salary in a wide range, and opportunities to impact patient care across CVS Health’s network.

Qualifications

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

Responsibilities

• Analyze reports for assignments, trends, metrics.
• Serve as first line for frontline staff questions on cases.
• Proctor RN/MD rounds as required and assist with escalated case reviews.

Skills

RN experience

Education

BSN preferred

Job description

CVS Health Corporation is seeking a Clinical Team Lead in Utilization Management for a remote role. You will analyze utilization data, support frontline staff on cases, and coordinate reviews to ensure appropriate healthcare services for members.

The position requires strong clinical judgment and communication across providers and teams. The role offers a comprehensive benefits package, a base salary in a wide range, and opportunities to impact patient care across CVS Health’s network.