Medical Director – Behavioral Health (Must reside in WV)

  • CVS Health
  • Remote
  • Sep 22, 2021
Physician Psychiatry

Job Description

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.

Fundamental Components:

• 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

Required Qualifications
MD or DO
Psychiatrist
Board certification
Substance abuse experience
Must reside in the state of WV

COVID Requirements
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.

  • If you are vaccinated, you are required to have received at least one COVID-19 shotprior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
Preferred but not required managed care experience

Child and Adolescence sub specialty

Education
MD or DO

Business Overview
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.