Medical Director - Behavioral Health - ABH LA
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What you'll do
- 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
What they're looking for
- Board-certified Psychiatrist currently licensed in the State of Louisiana or with the ability to become licensed in the State of Louisiana.
- Active and current state medical license without encumbrances, and ability to obtain other state licenses.
- This role requires the ability to get additional state licensures and provide UM coverage across multiple different state health plans.
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
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
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.
Position Summary
This is a remote-based (work from home) role.
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 as Medical Director (Behavioral Health), you will:
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.
Perform other duties as deemed necessary.
Required Qualifications
Board-certified Psychiatrist currently licensed in the State of Louisiana or with the ability to become licensed in the State of Louisiana.
Active and current state medical license without encumbrances, and ability to obtain other state licenses.
This role requires the ability to get additional state licensures and provide UM coverage across multiple different state health plans.
Preferred Qualifications
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
Education
MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine)
Pay Range
The typical pay range for this role is:
$174,070.00 - $374,920.00
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. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Company
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