Medical Director (Behavioral Health)

Job Description
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 has Medical Director (Behavioral Health) you will:

* Provide comprehensive behavioral health care management to facilitate delivery of appropriate quality care and improve program/operational efficiency involving clinical issues
* 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 development, implementation, and evaluation of clinical/medical programs
* 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 appeals process, including the investigation of adverse events and quality of care concerns
* 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

Pay Range
The typical pay range for this role is:
Minimum: 141,500
Maximum: 302,500

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
* Board Certification in Child Psychiatry is required.
* Minimum 5 years of clinical practice experience in the health care delivery field as a psychiatrist.
* Experience with managed care utilization review is preferred.

COVID Requirements


COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications
* Managed care experience, as a provider and manager of care
* Utilization review or physician advisor experience
* Experience in the area of Autism and ABA is preferred

Education
* Active and current state medical license without encumbrances.
* M.D. or D.O., Board Certification in Child Psychiatry including post-graduate direct patient care experience

Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.