CVS Health-posted 2 months ago
$184,112 - $396,550/Yr
Full-time • Senior
Work at Home, IL
5,001-10,000 employees
Ambulatory Health Care Services

The ABHIL Chief Psychiatrist (Senior Medical Director) will serve as a strategic and operational partner to the State, CEO, COO, Health Service Officer, and other executive team members in managing all Behavioral Health activities by driving clinical excellence, achieving measurable health outcomes, and supporting quality and medical management in a highly matrixed environment. The ABHIL Chief Psychiatrist will also support national strategic processes and priorities as well as conceptualization, design, and implementation of strategic priorities for Behavioral Health in the IL HealthChoice Medicaid program. The ABHIL Chief Psychiatrist will be responsible for cost containment outcomes and defined KPI's and overall growth and success of the plan through effective clinical leadership in support of behavioral health across all populations. Accountable for overall plan results and the delivery of high-quality cost-effective products and services that strategically align to the goals of the State partner. Ensures members get the right health care treatment for their needs, working to eliminate low value care, over and underutilization of health care services in alignment with the Quintuple AIM.

  • Develop, implement, support, and promote state clinical programs, population health strategies, tactics, policies, and programs that drive the delivery of high value healthcare.
  • Review, interpret and analyze data and trends at State level in: UM, CM, Pop Health, LTSS and Health Equity.
  • Serve as clinical executive leader for State regulators, providers, and other key partners.
  • Ensure clinical programs are compliant with all national and state regulations.
  • Lead clinical strategy across all HFS pillars and HealthChoice Illinois populations.
  • Provide direction, support and medical expertise and oversight to all areas within the clinical services.
  • Collaborate with Medical Management stakeholders both internally and externally.
  • Build and inspire a culture of continuous improvement for better quality of care.
  • Support the UM team in predetermination reviews and provide clinical, coding, and reimbursement expertise.
  • Investigate and implement new medical policies based on clinical expertise and data analysis.
  • Serve as clinical liaison to network providers and facilities.
  • Partner with Plan leaders, Network, and provider relations teams to drive differentiated provider engagement.
  • Support key state programs tied to healthcare transformation collaboratives and CMS 1115 waiver programs.
  • Use data analytics to inform and influence population health.
  • Collaborate and partner with SDoH teams to develop strategy to identify, engage, and improve the lives of members.
  • Collaborate with and provide subject matter expertise to the product team.
  • At least three years' experience in the health care delivery system e.g., clinical practice and health care industry.
  • Preferred 3 years of experience Medicaid and managed care experience.
  • Must be a resident of Illinois and a physician with a current, unencumbered IL Medical license.
  • Board Certification in a recognized specialty including post-graduate direct patient care experience.
  • Demonstrated experience in population health management and managed Care.
  • Passion and ability to influence and drive better outcomes in healthcare delivery.
  • Understanding of Value Based Contracting/Accountable Care.
  • Affordable medical plan options.
  • 401(k) plan (including matching company contributions).
  • Employee stock purchase plan.
  • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs.
  • Confidential counseling and financial coaching.
  • Paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access.
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