Behavioral Health Medical Director

CVS Health

Medical Director overseeing behavioral health management for Aetna, a CVS Health Company, providing clinical quality and utilization management expertise in a remote role.

Posted 5/22/2026full-timeRemote • Kentucky • 🇺🇸 United StatesLead💰 $174,070 - $374,920 per yearWebsite

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

psychiatryutilization managementclinical practicemedical necessity decisionsbehavioral health care managementquality improvementclinical program developmentadverse event investigationmedical policy interpretationcare management

Soft Skills

leadershipcommunicationcollaborationoversightconsultationtrainingproblem-solvinginterdisciplinary teamworkpatient advocacyquality assurance

Tools & Technologies

NCQA standardsclinical practice guidelinesmedical necessity criteriaaction planscare management systemsquality improvement frameworkshealth care delivery systemsutilization review processeselectronic health recordstelehealth platforms

Certifications & Qualifications

Board-certified PsychiatristChild/Adolescent Board Certificationactive state medical license

Industry Keywords

managed carehigh-risk casesclinical oversightquality of caretreatment resistant illnessesbehavioral healthhealth care deliveryclinical/medical programsmedical necessitystate licensing

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

Board-certified Psychiatrist currently licensed in the State of Kentucky or with the ability to become licensed in the State of Kentucky
Active and current state medical license without encumbrances, and ability to obtain other state licenses.
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

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
other resources, based on eligibility