Remote Behavioral Health SIU Medical Director

CVS Health; Hartford (CT); Remoto; USD 174.000 - 375.000; Tempo pieno

Vantaggi offerti da questo lavoro

Bonus eligibility

Equity awards

Comprehensive benefits

Descrizione del lavoro

CVS Health invites psychiatrists to join the Behavioral Health SIU as Medical Director, turning clinical insight into national impact. This full-time, remote role supports investigations to safeguard members and resources while applying psychiatric expertise to reviews of records, CPT/HCPCS codes, and related actions.

You will lead cross-functional collaborations with clinical, legal, compliance and data teams, present clear findings, and testify when required.

Competenze

• Five or more years of experience in a health care delivery setting, including clinical practice.
• Board certification in psychiatry; active, unrestricted medical license(s).
• Knowledge of policies and procedures governing payment of health care claims.

Mansioni

• Serve as the psychiatric advisor to SIU investigators and leaders, reviewing medical records, coding, and claims.
• Proactively surface new investigative opportunities while providing clinical support for active investigations and related legal actions.
• Use clinical expertise, population-level data, advanced analytics, AI, and practice-pattern insights to identify trends, prioritize investigations, and scale clinical impact.
• Lead cross-functional investigations with clinical, claims, legal, compliance, network, quality, data, and operational partners to address root causes and implement sustainable solutions.
• Assess member risk and care variation, document clear findings, and translate complex evidence into recommendations for leaders, customers, and other stakeholders.
• Prepare well-supported cases for clinical and legal review and, when required and approved by Legal, provide testimony in civil or criminal proceedings.
• Conduct required peer-to-peer reviews and model Aetna’s Employee Competencies in all interactions.

Conoscenze

Psychiatry knowledge

Clinical judgment

Cross-functional collaboration

Investigations & analytics

Formazione

MD/DO, psychiatry board certification

Active, unrestricted medical license

Strumenti

CPT coding guidelines

HCPCS coding guidelines

Descrizione del lavoro

CVS Health invites psychiatrists to join the Behavioral Health SIU as Medical Director, turning clinical insight into national impact. This full-time, remote role supports investigations to safeguard members and resources while applying psychiatric expertise to reviews of records, CPT/HCPCS codes, and related actions.

You will lead cross-functional collaborations with clinical, legal, compliance and data teams, present clear findings, and testify when required.