Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Job Overview
Aetna Better Health of Louisiana is seeking a dedicated and experienced Behavioral Health Medical Director. The ideal candidate will be a board-certified psychiatrist with a current, unencumbered license from the Louisiana State Board of Medical Examiners, and at least three (3) years of training in a medical specialty. The Behavioral Health Medical Director will ensure timely medical decisions, including after-hours consultation, and will share responsibility for managing the behavioral health services delivery system.Key Responsibilities
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• Participation in the development of clinical practice standards, policies, and procedures.
• Behavioral health care management performance and coordination with physical health care management.
• Participation in state led meetings with other medical directors and behavioral health MCO stakeholder meetings and other agency/stakeholder meetings when requested.
• Oversight and implementation of the utilization management program for behavioral health services, including monitoring for over/under-utilization.
• Ensuring consistency in the application of utilization management standards, including those implemented by subcontracted entities for BH services.
• Overseeing the complaint and grievance process for behavioral health denials, including state fair hearings and external review organizations.
• Review and resolution of quality-of-care concerns.
• Participation in clinical staff recruitment and ongoing performance improvement.
• Provide strategic oversight and leadership for all behavioral health activities within the health plan.
• Serve as the subject matter expert on behavioral health for ABHLA, ensuring compliance and alignment with state regulations and expectations.
• Lead and coordinate efforts with the state and other health plan colleagues to promote integrated care models.
• Oversee coordination activities with the state, ensuring effective collaboration and adherence to regulatory requirements.
• Work closely with health plan leadership, the Chief Medical Officer, other Medical Leadership, Pharmacy Director, clinical staff (including those in utilization management, care management, quality management), and colleagues within network and provider relations, to enhance the delivery of holistic and integrated care.
• Contribute to the development and implementation of policies and procedures that support the health plan's objectives and comply with state guidelines.
• Advocate for and implement innovative approaches to behavioral health care, promoting evidence-based practices that enhance patient outcomes.
• Support duties as required regarding utilization management of the service benefit and pharmacy benefit within the state health plan and additional duties as assigned.Required Qualifications
• Board-certified in Psychiatry.
• Louisiana Residency
• Current, unencumbered medical license from the Louisiana State Board of Medical Examiners.
• At least three (3) years of training in a medical specialty.
• Experience in managing behavioral health services and working with multiple child-serving systems.
• Strong leadership and communication skills.
• Ability to attend in-person meetings and manage after-hours consultations when needed.
Preferred Qualifications
- Previous UM Experience with a Health Plan or Health / Hospital System
- MD or DO
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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS HealthWe anticipate the application window for this opening will close on: 12/31/2024Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.