RN Clinical Lead, Utilization Management

CVS Health Corporation; United States; Remote; USD 67,000 - 143,000; Full time

Job summary

CVS Health is seeking a Clinical Team Lead in Utilization Management to guide clinical decisions, coordinate care, and monitor outcomes. The role requires several years of RN experience and active licensure, with a 24/7 operation pattern and the possibility of weekend/evening shifts.

You will analyze trends, support frontline staff, and collaborate with providers to ensure appropriate services and benefits across the continuum of care.

Qualifications

• 3+ years of experience as a Registered Nurse in adult acute care/critical care is required.
• Active current and unrestricted RN licensure in state of residence.
• Utilization Management operation runs 24/7 with weekend/holiday/evening hours.

Responsibilities

• Analyze reports for assignments/trends/metrics.
• Serve as first point of contact for frontline staff questions on cases.
• Proctor RN/MD rounds when required.
• Assist with escalated case reviews/facility issues.
• Render coverage determinations/recommendations using appropriate criteria and guidelines.

Skills

RN experience

Clinical assessment

Utilization Management

Education

Associate or BSN in Nursing (BSN preferred)

Job description

CVS Health is seeking a Clinical Team Lead in Utilization Management to guide clinical decisions, coordinate care, and monitor outcomes. The role requires several years of RN experience and active licensure, with a 24/7 operation pattern and the possibility of weekend/evening shifts.

You will analyze trends, support frontline staff, and collaborate with providers to ensure appropriate services and benefits across the continuum of care.