Clinical Team Lead, Utilization Management

CVS Health

. Analyze reports for assignments, trends, metrics, and issues .

Posted 10/6/2026full-timeRemote • Illinois • United StatesSenior💰 $66,575 - $142,576 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical criteria application and utilization management, with strong communication skills to facilitate care coordination and promote healthcare service quality. Proficient in navigating multiple systems and managing case reviews in a fast-paced environment.

Highest-signal resume keywords

Registered Nurse ExperienceUtilization ManagementClinical Criteria ApplicationEffective Communication SkillsManaged Care Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Information GatheringCoverage DeterminationCase Review AssistanceProficiency in Computer SkillsAbility to MultitaskPrioritization SkillsClose Inspection of DocumentsAdaptability in Fast-Paced Environment

Soft Skills

Effective Verbal CommunicationEffective Written Communication

Certifications & Qualifications

Active RN Licensure

Industry Keywords

Adult Acute CareCritical CareHealthcare Service QualityBenefit Utilization24/7 Operation

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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