Medical Director - Behavioral Health, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

174070.00 - 374920.00 USD / Year

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Job Description:

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. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Responsibility:

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

Requirements:

Board Certification in Psychiatry
Active and current state medical license without encumbrances, and ability to obtain other state licenses

Nice to have:

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

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
August 10, 2025

Expiration:
August 22, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Medical Director - Behavioral Health