Job Description

Medical Director - Behavioral Health, Aetna Medicaid At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. 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. Responsibilities 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 Required Qualifications Board Certification in Psychiatry Active and current state medical license without encumbrances, and ability to obtain other state licenses. Preferred Qualifications 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 Education MD or DO. Pay Range The Typical Pay Range For This Role Is $174,070.00 - $374,920.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Benefits Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit We anticipate the application window for this opening will close on: 09/26/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr CVS Health

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