[Hiring] Medical Director - Behavioral Health @CVS Health

Role Description

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.
• 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.

Qualifications

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

Requirements

• This role requires the ability to get additional state licensures and provide UM coverage across multiple different state health plans.

Preferred Qualifications

• 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.

Education

• MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine).

Pay Range

The typical pay range for this role is: $174,070.00 - $374,920.00. This 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. This position also includes an award target in the company’s equity award program.

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Application Information

We anticipate the application window for this opening will close on: 10/23/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.