Clinical Team Lead, Utilization Management

Job not on LinkedIn

🔥 2 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $66.6k - $142.6k / year

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Analyze reports for assignments, trends, metrics, and issues • Serve as the first point of contact for frontline staff questions about cases • Proctor RN/MD rounds as required • Assist with escalated case reviews and facility issues • Gather clinical information and apply clinical criteria, guidelines, policies, procedures, and judgment to render coverage determinations or recommendations • Communicate with providers and other parties to facilitate care and treatment • Identify members for referral opportunities involving other products, services, or programs • Identify opportunities to promote healthcare service quality and effective benefit utilization • Consult with and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management • Perform work in a typical office environment with productivity and quality expectations

🎯 Requirements

• 3+ years of experience as a Registered Nurse in an adult acute care/critical care setting • Active, current, and unrestricted RN licensure in the state of residence • Ability to work weekends, holidays, and evening hours in a 24/7 operation • Managed Care experience preferred, especially Utilization Management • Preference for candidates residing in Central time zones • Associate or Bachelor of Science in Nursing; BSN preferred • Proficiency with computer skills, including navigating multiple systems and keyboarding • Effective verbal and written communication skills • Ability to multitask, prioritize, and adapt to a fast-paced, changing environment • Ability to perform close inspection of handwritten and computer-generated documents and PC monitors • Ability to sit for extended periods, talk on the telephone, and type on a computer

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program in addition to base pay