RN Clinical Team Lead, Utilization Management

CVS Health Corporation; Illinois; Hybrid; USD 67,000 - 143,000; Full time

Benefits offered by this job

Comprehensive benefits package

Job summary

CVS Health Corporation is seeking a Clinical Team Lead for the Utilization Management team. You will apply clinical judgment to plan, coordinate, and evaluate healthcare services and benefits for members, while working in a fast-paced, collaborative environment.

The role emphasizes data analysis, case review, and cross-functional communication to improve quality and efficiency of care delivery. Evening/weekend coverage is required in this 24/7 operation.

Qualifications

• Active RN license in state of residence.
• 3+ years of experience as a Registered Nurse in adult acute/critical care.

Responsibilities

• Analyze reports for trends, metrics, and issues.
• Serve as first point of contact for frontline staff questions on cases.
• Assist with escalated case reviews and facility issues.
• Gather clinical information and apply criteria to render coverage determinations.
• Communicate with providers to facilitate care and identify referral opportunities.
• Coordinate with internal/external teams for utilization/benefit management.

Education

Associate or Bachelor of Science in Nursing (BSN preferred)

Job description

CVS Health Corporation is seeking a Clinical Team Lead for the Utilization Management team. You will apply clinical judgment to plan, coordinate, and evaluate healthcare services and benefits for members, while working in a fast-paced, collaborative environment.

The role emphasizes data analysis, case review, and cross-functional communication to improve quality and efficiency of care delivery. Evening/weekend coverage is required in this 24/7 operation.