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CVS Health · 23 hours ago

Clinical Team Lead

United States

Full-time

Remote

Mid, Senior Level

$61K/yr - $130K/yr

4+ years exp

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care. The DRG Clinical Team Lead provides leadership support and clinical expertise to a team of nurses handling DRG appeals and case reviews, balancing hands-on clinical work with coaching and process improvement.

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Responsibilities

Oversee daily DRG appeal and clinical review operations, ensuring timely, accurate, and compliant case handling

Provide clinical guidance and mentorship to team members; serve as a resource for complex cases and problem-solving

Assist with monitoring productivity and quality metrics; identify trends, proactively address barriers, and coach for improvement

Foster a collaborative, inclusive environment where colleagues feel supported and empowered

Assist with leading team huddles, knowledge-sharing sessions, and process improvement initiatives

Ensure adherence to all regulatory, compliance, and organizational policies

Collaborate with leaders, physicians, and other team members to optimize workflows and patient outcomes

Support onboarding, training, and development for new and existing team members

Model CVS Health values in all interactions and decision-making

Qualification

Active RN licenseDRG methodology knowledgeClinical nursing experienceEMR/healthcare systemsLeadership experienceCoaching abilityEmpathyCommunication skillsProblem-solving skillsOrganizational skillsTeam playerAttention to detail

Required

Active RN license required

Minimum 3+ years of clinical nursing experience, in addition to 1+ years in DRG or appeals review (preferred)

Demonstrated leadership or mentorship experience in a healthcare setting

Strong knowledge of DRG methodology, clinical documentation, and regulatory requirements

Excellent communication, problem-solving, and organizational skills

Experience with EMR/healthcare systems and data-driven decision-making

Approachable and proactive team player

High attention to detail and commitment to quality

Ability to coach, motivate, and hold others accountable with empathy

Comfortable navigating change and driving continuous improvement

Preferred

Previous experience as a Team Lead and/or in a formal leadership role within a healthcare or clinical setting

Benefits

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.