Description
We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience.
This is a remote-based (work from home) role. Candidates residing in Texas 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 healthcare.
In this role as Medical Director (Behavioral Health), you will:
- Provide leadership and day-to-day physician oversight for the utilisation management team, including the management of high-risk cases and medical necessity decisions
- Provide comprehensive behavioural healthcare 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 utilisation 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 utilisation 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 behavioural 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 Texas or with the ability to become licensed in the State of Texas
- 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 Texas
- Minimum 5 years of clinical practice experience in the healthcare delivery field as a psychiatrist
- Experience with managed care, as a provider and manager of care utilisation 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
Benefits
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.