Behavioral Health Medical Director - ABH KY

CVS Health • Prior Lake, VT

10d • Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary 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. This is a remote-based (work from home) role. In this role as Medical Director (Behavioral Health), you will: Provide leadership and day-to-day physician oversight for utilization management team, including the management of high-risk cases and medical necessity decisions Provide comprehensive behavioral health care management to facilitate delivery of appropriate quality care and improve program/operational efficiency involving clinical issues Participate in the appeals process, including the investigation of adverse events and quality of care concerns Provide psychiatric leadership to an interdisciplinary utilization management team, including medical/clinical oversight, consultation and training Provide day-to-day physician oversight including management of high-risk cases throughout treatment/levels of care and medical necessity decisions Assist with the development, implementation, monitoring and evaluation of the utilization management program and action plan, ensuring quality and appropriateness of care Assist with the development, implementation and interpretation of medical policy including medical necessity criteria, clinical practice guidelines and new technology assessments Participate in the development, implementation, and evaluation of clinical/medical programs Confer with behavioral health practitioners regarding the care of patients with severe, complex and/or treatment resistant illnesses Identify and address quality of care concerns with providers involved in a member's care Provide psychiatric leadership for NCQA-compliant clinical quality improvement activities in collaboration with clinical and quality improvement staff Participate in the triage and referral for care management Provide weekend coverage every 6-7 weeks. Perform other duties as deemed necessary.

Requirements

• Board-certified Psychiatrist currently licensed in the State of Kentucky or with the ability to become licensed in the State of Kentucky
• Active and current state medical license without encumbrances, and ability to obtain other state licenses.
• MD or DO.

Nice To Haves

• Minimum 5 years of clinical practice experience in the health care delivery field as a psychiatrist.
• Experience with managed care, as a provider and manager of care utilization review or physician advisor experience.
• Child/Adolescent Board Certification

Responsibilities

• Provide leadership and day-to-day physician oversight for utilization management team, including the management of high-risk cases and medical necessity decisions
• Provide comprehensive behavioral health care management to facilitate delivery of appropriate quality care and improve program/operational efficiency involving clinical issues
• Participate in the appeals process, including the investigation of adverse events and quality of care concerns
• Provide psychiatric leadership to an interdisciplinary utilization management team, including medical/clinical oversight, consultation and training
• Provide day-to-day physician oversight including management of high-risk cases throughout treatment/levels of care and medical necessity decisions
• Assist with the development, implementation, monitoring and evaluation of the utilization management program and action plan, ensuring quality and appropriateness of care
• Assist with the development, implementation and interpretation of medical policy including medical necessity criteria, clinical practice guidelines and new technology assessments
• Participate in the development, implementation, and evaluation of clinical/medical programs
• Confer with behavioral health practitioners regarding the care of patients with severe, complex and/or treatment resistant illnesses
• Identify and address quality of care concerns with providers involved in a member's care
• Provide psychiatric leadership for NCQA-compliant clinical quality improvement activities in collaboration with clinical and quality improvement staff
• Participate in the triage and referral for care management
• Provide weekend coverage every 6-7 weeks.
• Perform other duties as deemed necessary.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Ph.D. or professional degree
• Number of Employees: 5,001-10,000 employees