CVS Health Behavioral Health Medical Director Baton Rouge, Louisiana Apply Now
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Job Purpose and Summary:
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.
Primary Job Duties & Responsibilities:
- Collaborates with health plan Sr Leadership to identify, develop, implement, and evaluate the effectiveness of strategic initiatives including trends, policies and programs, designed to drive the delivery of high value healthcare.
- Ensures plan makes timely medical decisions, including after-hours consultation as needed.
- Leads all major clinical, population health management, and quality improvement components of the aligned plan.
- Develops, implements and interprets medical policies and procedures, including service authorization, claims review, discharge planning, and medical reviews performed through the aligned plan's grievance and appeal system.
- Leads the administration of all medical management activities of the aligned Plans.
- Plays a lead role in monitoring the overall safety of members with complex and or comorbid medical conditions.
- Coordinates with the MCOs' care management staff and providers on medical services not included in the aligned plan's service array.
- Serves as a key clinical lead in developing and implementing evidence-based clinical policies and practices.
- Participates in regulatory/accreditation reviews.
- Works with MCO's clinical leadership as needed for integration of all health care needs and services for aligned plan's members.
Position Description:
Aetna Medicare Duals Center of Excellence is searching for a board-certified adult psychiatrist with at least five years’ experience in mental health and substance use disorder services for this work-from-home position. There will be occasional travel based on need which may equate to 10% as needed. This person will oversee and be responsible for all behavioral health activities in the health plans, including oversight of coordination activities with the federal and state agencies.
Required Qualifications:
- Five (5) or more years of experience in Behavioral Health in the healthcare delivery system.
- Three (3) or more years of experience in Managed Care.
- Board Certification in ABMS recognized specialty of Adult Psychiatry.
- Active and current state medical license without encumbrances.
- M.D. or D.O.
- Strong strategic thinking and collaborative skills.
- Ability to analyze data, recognize trends and create action plans.
- Independently motivated and capable of researching and adjudicating Medicare and Medicaid benefit and coverage decisions.
- Strong communication skills both written and verbal.
CVS Health is an equal opportunity/affirmative action employer. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW (https://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf) and EEO IS THE LAW SUPPLEMENT (https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm).
Pay Range
The typical pay range for this role is: $174,070.00 - $374,900.00. 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.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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