Clinical Team Lead - Work at Home - Oklahoma

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As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Team Lead – Utilization Management Summary

The Team Lead serves as a frontline leader overseeing a team within the Utilization Management (UM) department, including intake, prior authorization, and concurrent review functions. This role ensures daily clinical and operational efficiency by monitoring workflows, staff capabilities, and performance metrics.

Key Responsibilities:

• Direct team activities to meet production, quality, and performance goals.

• Train, mentor, and audit new hires; ensure compliance with contract and regulatory standards.

• Act as a primary contact for escalated service issues, supporting members, providers, and internal teams.

• Lead performance and quality improvement initiatives and collaborate across departments.

• Serve as a subject matter expert on contractual regulations and clinical workflows.

• Support supervisors, manage caseloads, and assist with scheduling and coverage planning.

• Promote teamwork, confidentiality, and effective communication.

• Coordinate with medical leadership and other market team leads on shared projects.

Required Qualifications:

• Possess an active, unrestricted Registered Nurse (RN) license in the state of Oklahoma.

• Demonstrated understanding of National Committee for Quality Assurance (NCQA) standards.

• Ability to support a care delivery model that promotes optimal member health outcomes, manages costs effectively, and aligns with governmental and purchaser expectations.

• Skilled in enhancing operational efficiency, meeting state compliance standards, ensuring member and provider satisfaction, and upholding a strong commitment to quality care.

• Minimum of two years of clinical experience in a managed care setting is required.

• Proficient in computer usage, including navigating multiple systems and performing accurate keyboarding tasks.

• Highly organized with strong time management skills

Preferred Qualifications:

• Proven ability to mentor and guide staff to effectively meet organizational goals.

• Outstanding verbal and written communication skills.

• Highly efficient with time management and exceptionally well-organized.

• Over two years of experience leading performance improvement initiatives.

• Extensive background in performance and quality improvement strategies.

Education:

Associates Degree in Nursing Required.

Preference to a BSN

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $116,760.00

This 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues includi