Clinical Team Lead - Work at Home - Oklahoma

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.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.

• 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

• 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.

• 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 including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.