Clinical Team reputed company - Work at Home - Oklahoma

At reputed company, 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 reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Team reputed company – Utilization Management Summary The Team reputed company serves as a frontline leader overseeing a team reputed company the Utilization Management (UM) department, including intake, prior authorization, and reputed company 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.
• reputed company 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 reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company 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 reputed company 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 09/21/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job