Position Summary 

The Utilization Management Clinical Team Lead is an RN, fully remote position. 

No travel is expected with this position. 

The Team Lead is accountable to leadership to support the day-to-day operations of the team. This position has no supervisory oversight of staff. 
 
The Team Lead supports the onboarding of new staff as well as quality monitoring, assignment triage and leading projects as assigned. The Team Lead is the first line of contact for staff for clinical issues. The Team Lead provides ongoing communication and updates to leadership and contributes and participates in team meetings.  

The Team Lead role encompasses the following (not an all-inclusive list): 

·       Promote cooperation and team building between all department members 

·       Serve as a resource to team members 

·       Serve as a content model expert and mentor to the team regarding practice standard, quality of interventions, problem resolution and critical thinking 

·       Ensure adherence to plan sponsor specifics and TATs 

·       Develop, implement, and support program policies and procedures 

·       Utilize critical thinking skills to raise the level of team’s performance 

·       Mentor the team; monitoring and providing feedback regarding performance relative to best practices 

·       Act as a role model for the Heart at Work Behaviors, particularly regarding company policies on confidentiality 

·       Communicate effectively with a variety of audiences 

·       Able to handle case escalations 

·       Well organized and able to prioritize tasks 

·       Support a positive work environment that promotes the concept of teamwork 

·       Support to Associate Managers and Supervisors as directed 

·       May have responsibility for their own case load work 

·       Respond to issues and inquiries as needed 

·       Sedentary work involving periods of sitting, talking, hearing, work requires visual acuity to perform close inspection of handwritten and computer-generated documents as well as a PC monitor 

 
Required Qualifications 

·       3+ years of experience as a Registered Nurse  

·       Must have active current and unrestricted RN licensure in state of residence.  

·       Completion of 6 preceptor course with in CVS/Aetna 

·       Most be current on annual preceptor call 

Must have UM experience

 
Education 

Associate Degree in Nursing is minimum required, BSN preferred.