Psychiatry Full-Time position in Tallahassee, Florida - CVS Health

Description

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. You can live anywhere in the U.S. \*\

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In this role has Medical Director (Behavioral Health) you will:
\* Provide comprehensive behavioral health care management to
facilitate delivery of appropriate quality care and improve
program/operational efficiency involving clinical issues
\* Provide leadership and day-to-day physician oversight for
utilization management team, including the management of
high-risk cases and medical necessity decisions
\* Participate in the development, implementation, and evaluation
of clinical/medical programs
\* 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
\* 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
\* Participate in the appeals process, including the investigation
of adverse events and quality of care concerns
\* 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


Required Qualifications
\* Board Certification in Adult Psychiatry is required.
\* Minimum 5 years of clinical practice experience in the health
care delivery field as a psychiatrist.

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Preferred Qualifications
\* Managed care experience, as a provider and manager of care
\* Utilization review or physician advisor experience

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Education
\* Active and current state medical license without
encumbrances.
\* M.D. or D.O., Board Certification in Adult Psychiatry including
post-graduate direct patient care experience