Behavioral Health Medical Director

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🕒 May 22

🐎 Kentucky – Remote

🐎 Kentucky – Remote

💵 $174.1k - $374.9k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• 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.

🎯 Requirements

• Board-certified Psychiatrist currently licensed in the State of Kentucky or with the ability to become licensed in the State of Kentucky • Active and current state medical license without encumbrances, and ability to obtain other state licenses. • 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

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility