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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 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
* provide coverage for appeals as neede
Required Qualifications
* Board Certification in Psychiatry

* Minimum 5 years of clinical practice experience in the health care delivery field as a psychiatrist.

Preferred Qualifications
* Experience with managed care, as a provider and manager of care

utilization review or physician advisor experience.

Education
* Active and current state medical license without encumbrances

MD or DO.

Pay Range

The typical pay range for this role is:

$174,070.00 - $374,900.00

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. 
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 09/30/2024