Medical Director - Behavioral Health (New Jersey)
CVS Pharmacy - Trenton, NJ
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Job DescriptionAetna, 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 and can be based anywhere in the US.Aetna Medicaid is looking for a Medical Director (Behavioral Health) to be part of the team. The Medical Director will develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. Aetna operates Medicaid managed care plans in fifteen states: Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia, and West Virginia. The medical director is a work-at-home position supporting the Aetna Medicaid line of business in most of these states, offering a variety of physical and behavioral health programs and services to its membership.This role will focus on the State of New Jersey.This position will primarily support behavioral health utilization management transactional reviews such as medical and pharmacy prior authorization, including weekend coverage when assigned, as well as appeals and quality of care case reviews. The Medical Director will lead daily rounds with the UM nurse and case management teams.Required Qualifications Board Certification in a psychiatric specialty is required. Minimum 3 years of clinical practice experience in the health care delivery field as a psychiatrist. Experience with managed care (Medicaid and Medicare preferred) utilization review is preferred. Active and current state medical license without encumbrances is required.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Active and current New Jersey state medical license without encumbrances is required. Multiple state licensure is a plus. Health plan/payor experience.EducationActive and current state medical license without encumbrancesM.D. or D.O., Board Certification in Psychiatry including post-graduate direct patient care experienceBusiness OverviewBring your heart to CVS HealthEvery 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Created: 2024-09-07