Aetna Medicaid is looking for a behavioral health medical director to be part of the team. The medical director will develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna.
Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.
Aetna operates Medicaid managed care plans in sixteen states: Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia, and West Virginia.
The medical director is a work-at-home position supporting the Aetna Medicaid line of business; primarily in the state of West Virginia but filling in covering other states when needed in our fully integrated plans (Behavioral & Physical Health) offering a variety of physical and behavioral health programs and services to its membership.
• Utilization management – The medical director will perform concurrent and prior authorization reviews with peer to peer coverage of denials.
• Appeals – The medical director will perform appeals in the “round robin” for multiple plans and be first line for urgent requests.
• Pharmacy coverage – The medical director will perform pharmacy reviews to cover for medical directors on PTO, leave, and as requested by plan leadership.
• The medical director will be the primary coverage for plans when a medical director is out on PTO, leave, or during a time of transition.
Background / Experience: Minimum 3-5 years of clinical practice experience in the health care delivery field as a psychiatrist. Experience with managed care (Medicaid and Medicare preferred) utilization review is preferred.
Preferred Education: The minimum level of education required for candidates in this position is MD or DO certification
Licenses: Active and current state medical license without encumbrances is required. West Virginia License or ability to obtain a West Virginia License is REQUIRED.
Multiple state licensure is a plus.
Board Certification in a psychiatric specialty is required.
• Skills Benefits Management/Interacting with Medical Professionals-MASTERY
• Proficiency with Microsoft Outlook, Word, Excel, PowerPoint, and Teams strongly preferred
MD or DO
Substance abuse experience
Must reside in the state of WV
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
Preferred but not required managed care experience
Child and Adolescence sub specialty
MD or DO
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.