Medical Director - Behavioral Health

CVS Health; Texas; Ibrido; USD 174.000 - 375.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical coverage

Dental coverage

Vision coverage

Retirement plan

Descrizione del lavoro

CVS Health is seeking a Board-certified psychiatrist for a remote-based role with a Texas preference. You will oversee utilization management, provide behavioral health leadership and collaborate with cross-functional teams to ensure medical necessity and quality care.

The role requires Texas licensure (or eligibility) and may involve licensure in additional states. This full-time position offers a competitive pay range, comprehensive benefits, and potential incentives.

Competenze

• Board-certified psychiatrist licensed in Texas or eligible for licensure in Texas.
• Active medical license with ability to obtain other state licenses as needed.
• Ability to obtain additional state licenses for UM coverage across plans.

Mansioni

• Provide leadership and day-to-day physician oversight for the utilization management team.
• Lead behavioral health care management to improve quality and efficiency.
• Participate in appeals and investigate adverse events and quality concerns.
• Provide psychiatric leadership to an interdisciplinary UM team.
• Oversee treatment levels and medical necessity decisions across care.
• Support development and evaluation of the UM program and action plans.
• Contribute to medical policy and new technology assessments.
• Develop and evaluate clinical/medical programs.
• Collaborate with behavioral health providers on complex cases.
• Coordinate triage and referrals for care management.
• Provide weekend coverage every 6-7 weeks.

Conoscenze

Board-certified psychiatrist

Texas licensure

Medical license

Formazione

MD/DO

Descrizione del lavoro

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

This is a remote-based (work from home) role. Candidates residing in Texas are preferred. 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.

Responsibilities

• 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 Texas or with the ability to become licensed in the State of Texas
• Active and current state medical license without encumbrances, and ability to obtain other state licenses
• This role requires the ability to get additional state licensures and provide UM coverage across multiple different state health plans

Preferred Qualifications

• Preferred candidate will reside in the state of Texas
• 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 (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine)

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. 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.

Great 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 benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits 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 benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 11/14/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Our Work Experience

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.