[Hiring] Prior Authorization Clinical Team Lead @CVS Health

Role Description

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 but requires a solid understanding of the workflows, policies, and procedures to ensure the team is producing at a successful level. The Team Lead supports the onboarding of new staff as well as quality monitoring and assignment triage. The Team Lead is a single point and first line of contact for staff for clinical issues. They may lead projects as assigned. The Team Lead provides ongoing communication and updates to leadership and contributes and participates in team meetings. The role requires promoting cooperation and team-building between all department members.

• Serve as expert in contractual regulations.
• 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 performance targets.
• Implement and support program policies and procedures.
• Utilize critical thinking skills to raise the level of team performance.
• Training:
• Mentor the team, monitoring and providing feedback regarding performance relative to best practices.
• New-hires: Request access, plan orientation, schedule CORE training, train new-hires, perform quality audits on work completed, orient to UM, state contract requirements, Desktops/Job Aids, TAT, productivity goals, and serve as mentor after training completed.
• Act as a role model for the Aetna values, particularly regarding company policies on confidentiality.
• Communicate effectively with a variety of audiences.
• Well organized and able to prioritize tasks.
• Support a positive work environment that promotes the concept of teamwork.
• Support to Supervisors as directed.
• May have responsibility for their own caseload work.
• Respond to issues and inquiries as needed.
• Collaborate with other market Team Leads on shared projects.
• Complete quality audits on new hires per policy and quarterly as assigned.
• Assist manager with other tasks as assigned including PTO calendar and holiday schedule.
• Be on leadership on-call schedule for weekends.
• Assists with High Dollar Case reporting and presentation.
• Attend meetings when the manager is unable to attend.
• Coordinates assistance with other states and departments as needed.

Qualifications

• Active unrestricted RN licensure in Louisiana.
• 2 or more years clinical and managed care experience required.
• Requires proficiency with computer skills which includes navigating multiple systems and keyboarding.

Requirements

• Ability to mentor and support staff to meet business needs.
• Exceptional communication skills.
• Time efficient and highly organized.
• 2 or more years experience with performance improvement projects.
• Performance Improvement and Quality Improvement (PIP/QIP) experience required.

Education

• Bachelor’s degree preferred, Associates in Nursing required.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.