Behavioral Health Medical Director — AI Policy & Governance

CVS Health

About The Position

Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. Role summary: The Behavioral Health (BH) Medical Director (MD) for AI Policy & Governance provides clinical leadership to ensure artificial intelligence (AI)—including predictive models and generative AI—is designed, validated, implemented, and monitored in ways that are clinically sound, ethical, safe, compliant, and equitable. This role partners closely with enterprise AI governance bodies and risk stakeholders to align BH AI use cases to the company’s AI Governance Policy and related AI standards (including AI risk assessment and AI training expectations). As part of the BH Clinical Quality team, a successful candidate will partner and work closely with a team of colleagues focused on policy as well as internal and external quality assurance.

Requirements

MD or DO with board certification in Psychiatry
Active and unencumbered license to practice medicine
5 or more years of clinical experience post residency/fellowship
Significant experience in BH clinical leadership (health plan, provider organization, or integrated delivery setting)
Demonstrated experience with clinical governance, quality/safety programs, and clinical policy implementation
Experience evaluating or implementing AI/analytics tools in healthcare (model review, validation, monitoring, clinical workflow integration)

Nice To Haves

Familiarity with enterprise governance processes for AI use-case approvals and risk assessments
Background in utilization management, care management, or clinical operations support (helpful given medical director workflow expectations in some settings)
Proven track record of embedding AI into clinical workflows and driving adoption
Demonstrated ability to identify and scale AI-enabled clinical use cases across payor processes and relevant populations

Responsibilities

Provide clinical oversight for AI-enabled workflows impacting BH (e.g., risk stratification, care navigation, documentation support, utilization management support)
Establish clinical acceptability criteria (clinical validity, safety, workflow appropriateness) and ensure appropriate clinician-in-the-loop controls where needed
Establish criteria for AI vendor review in partnership with critical business partners to establish viability of proposed vendor AI policy, standards, and risk alignment
Translate enterprise AI governance requirements into BH–specific guardrails, decision pathways, and clinical review checkpoints aligned to the AI Governance Policy and the AI System Risk Assessment Standard
Partner with governance stakeholders to ensure AI tools/use cases complete required reviews and approvals (including use-case risk assessment and any associated controls)
Define clinical performance measures (effectiveness, safety signals, unintended consequences) and operational KPIs for BH AI solutions
Establish monitoring plans for model drift, changes in clinical practice guidelines, and emerging risk signals; recommend retraining, recalibration, or retirement when appropriate
Establish payment policy in partnership with network partners for AI supported clinical interventions within a provider/vendor partnership
Identify and mitigate BH–specific risks such as bias, stigma reinforcement, access inequities, and potential harms from automation
Ensure responsible use principles are embedded throughout the lifecycle, from concept through deployment and ongoing monitoring
Ensure equitable performance across populations (e.g., depending on how model was trained, training data may not always be representative), identify and mitigate algorithmic bias in care decisions; align AI deployment with organizational values and patient trust
Collaborate with Enterprise Data & AI Governance partners to ensure behavioral health AI initiatives uphold privacy, security, and ethical data practices, and align to enterprise guardrails and support models
Assess data quality, design and interpret pilots, A/B testing
Support clinician adoption through clear clinical guidance, training expectations, and workflow integration consistent with the organization’s AI training approach
Partner with operational leaders to ensure AI supports (rather than disrupts) care delivery and utilization workflows
Serve as a key clinical stakeholder for AI governance forums (e.g., AI Governance Board participation / representation as applicable)
Provide clinical leadership in multidisciplinary reviews with product, engineering, data science, compliance, legal, privacy, and security
As part of the clinical quality team, the successful candidate will provide coverage, support and expertise to the work of the team including clinical policy and quality assurance work within Aetna BH Medical Affairs
Exhibit behaviors as outlined in Employee Competencies
Be available for weekend coverage up to 4 times per year