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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​

Required Qualifications
* Board Certification in Adult Psychiatry is required. 
* Minimum 5 years of clinical practice experience in the health
care delivery field as a psychiatrist. 

Preferred Qualifications
* Managed care experience, as a provider and manager of care
* Utilization review or physician advisor experience

* Florida licensed or Florida license eligible a plus.

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

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. 
 
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: 10/31/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.