Medical Director - Behavioral Health - ABH OH

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About the role

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This is a remote-based (work from home) role. Candidates residing in Ohio are preferred. 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 • 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 • 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. Required Qualifications • Board-certified Psychiatrist currently licensed in the State of Ohio or with the ability to become licensed in the State of Ohio • Active and current state medical license without encumbrances, and ability to obtain other state licenses. • This role requires the ability to get additional state licensures and provide UM coverage across multiple different state health plans.  Preferred Qualifications • Preferred candidate will reside in the state of Ohio • 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 o

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