Medical Director - Behavioral Health, Aetna Medicaid

CVS Health

4d • Remote

About The Position

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. 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 position will primarily support the Medicaid plans for Kentucky and Louisiana but be expected to fill in for other states needed. Work at Home with Central Standard Time hours expected. This is a remote-based (work from home) role. In this role as Medical Director (Behavioral Health), you will:

Requirements

• Board Certification in Psychiatry
• Active and current state medical license without encumbrances, and ability to obtain other state licenses.

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
• 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
• 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
• 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: Director
• Education Level: Ph.D. or professional degree
• Number of Employees: 5,001-10,000 employees