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.
Job Title: DRG Clinical Team Lead
Position Overview:
This is a full-time remote position.
Hours for this position are Monday-Friday 8a-5p in time zone of residence.
The DRG Clinical Team Lead provides day-to-day leadership support, and clinical expertise to a team of nurses responsible for DRG (Diagnosis-Related Group) appeals and case reviews. This role balances hands-on clinical work with coaching, workflow oversight, and process improvement to drive high-quality outcomes and a positive, inclusive team culture.
Key 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.
Required Qualifications:
· 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 Qualifications
· Previous experience as a Team Lead and/or in a formal leadership role within a healthcare or clinical setting.
Education
· Associate’s degree or Diploma RN required
· BSN preferred
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$60,522.00 - $129,615.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base 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 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.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 01/12/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.