Clinical Team Lead
4062 Aetna Resources, LLCWe’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
UM (Utilization Management) Outpatient (OP) Clinical Team Lead Description Draft
Job Title: Clinical Team Lead
Position Overview:
This is a full-time remote position.
Hours for this position are Monday–Friday, 8am–5pm in the time zone of residence.
The UM OP Clinical Team Lead provides day-to-day leadership support and clinical expertise to a team of nurses responsible for Utilization Management (UM) Outpatient Appeal reviews and processes. This role balances hands-on clinical work with coaching, workflow oversight, and process improvement to drive high-quality outcomes and foster a positive, inclusive team culture.
Key Responsibilities:
Provide clinical guidance and mentorship to outpatient team members; serve as a resource for complex cases and problem-solving.
Assist with monitoring productivity and quality metrics; identify trends, proactively address barriers, and coach for improvement.
Foster a collaborative, inclusive environment where colleagues feel supported and empowered.
Assist with leading team huddles, knowledge-sharing sessions, and process improvement initiatives.
Ensure adherence to all regulatory, compliance, and organizational policies.
Collaborate with leaders, physicians, and other team members to optimize workflows and patient outcomes.
Support onboarding, training, and development for new and existing team members.
Model CVS Health values in all interactions and decision-making.
Required Qualifications:
Active RN license required.
Minimum 3+ years of clinical nursing experience, in addition to 1+ years in Utilization Management, case review, or prior authorization (preferred).
Demonstrated leadership or mentorship experience in a healthcare setting.
Strong knowledge of UM outpatient processes, clinical guidelines, and regulatory requirements.
Excellent communication, problem-solving, and organizational skills.
Experience with EMR/healthcare systems and data-driven decision-making.
Approachable and proactive team player.
High attention to detail and commitment to quality.
Ability to coach, motivate, and hold others accountable with empathy.
Comfortable navigating change and driving continuous improvement.
Preferred Qualifications:
Previous experience as a Team Lead and/or in a formal leadership role within a healthcare or clinical setting.
Education:
LPN, Associate’s degree or Diploma RN required.
BSN preferred.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$54,095.00 - $155,538.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.