[Hiring] Medical Director - Behavioral Health @CVS Health

Role Description

This is a remote-based (work from home) role. Candidates must reside in the state of Virginia.

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.

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 Virginia.
• Active and current state medical license without encumbrances, in the state of Virginia.
• This role requires the ability to get additional state licensures and provide UM coverage across multiple different state health plans.

Requirements

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

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.