Medical Director - Behavioral Health - Virginia

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.

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
• 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.

• 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. 

• 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)

The typical pay range for this role is: