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Medical Director - Behavioral Health

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States , Work at Home

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Category:
Health and Beauty

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Contract Type:
Not provided

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Salary:

174070.00 - 374920.00 USD / Year
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Job Description:

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. The hours for this role are Monday through Friday from 8:00 am to 5:00 pm Pacific Time. 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. In this role has Medical Director (Behavioral Health) you will: [see responsibilities]. Weekend coverage up to 4 times/year.

Job Responsibility:

  • Provide comprehensive behavioral health care management to facilitate delivery of appropriate quality care and improve program/operational efficiency involving clinical issues
  • Provide leadership and day-to-day physician oversight for utilization management team, including the management of high-risk cases and medical necessity decisions
  • Participate in the development, implementation, and evaluation of clinical/medical programs
  • 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
  • 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
  • Participate in the appeals process, including the investigation of adverse events and quality of care concerns
  • 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
  • Weekend coverage up to 4 times/year

Requirements:

  • Board Certification in Psychiatry
  • Minimum 5 years of clinical practice experience in the health care delivery field as a psychiatrist
  • Hold current California medical license or be able to obtain California, Texas and Arizona license
  • Active and current state medical license without encumbrances
  • MD or DO

Nice to have:

  • Experience with managed care, as a provider and manager of care
  • utilization review or physician advisor experience
  • Child/Adolescent Board Certification
What we offer:
  • Medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs
  • other resources

Additional Information:

Job Posted:
May 15, 2026

Expiration:
June 30, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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