Medical Director – Behavioral Health

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🔥 0 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – 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

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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 the behavioral health utilization management team • Manage high-risk cases and medical necessity decisions • Provide comprehensive behavioral health care management to support quality care and operational efficiency • Participate in appeals, adverse-event investigations, and quality-of-care concerns • Provide psychiatric leadership, consultation, and training to an interdisciplinary utilization management team • Develop, implement, monitor, and evaluate utilization management programs and action plans • Develop, implement, and interpret medical policies, medical necessity criteria, clinical practice guidelines, and new technology assessments • Participate in developing, implementing, and evaluating clinical and medical programs • Confer with behavioral health practitioners regarding severe, complex, or treatment-resistant illnesses • Address quality-of-care concerns with providers • Lead NCQA-compliant clinical quality improvement activities • Participate in triage and referral for care management • Provide weekend coverage every 6–7 weeks • Perform other duties as necessary

🎯 Requirements

• Board-certified Psychiatrist currently licensed in the State of Virginia • Active and current state medical license without encumbrances in Virginia • Ability to obtain additional state licensures and provide utilization management coverage across multiple state health plans • MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) • Minimum 5 years of clinical practice experience as a psychiatrist preferred • Experience with managed care, provider care utilization review, or physician advisor work preferred • Child/Adolescent Board Certification preferred

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being