Medical Director - Behavioral Health - Remote

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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

*Weekend coverage up to 4 times/year.

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.
*Child/Adolescent Board Cert

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 - $374,920.00