Behavioral Health Medical Director - ABH KY

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. Responsibilities Provide leadership and day‑to‑day physician oversight for the 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. 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‑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. 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 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. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr Capacity Path