Behavioral Health Medical Director - ABH

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 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. **This is a remote-based (work from home) role.** 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 tec...