Behavioral Health Medical Director, ABH KY at CVS Health

Overview

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 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 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. 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 or DO. 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.

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. This full‑time position is eligible for a comprehensive

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• package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The

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• for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available

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• are provided during the application process and on

Benefits

• Moments . We anticipate the application window for this opening will close on: 07/17/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.