CVS Health Kentucky, Alabama
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Search by job title, category, or Military MOS code Medical Director – Behavioral Health (Aetna Medicaid) Job ID: 1771898BR Category: Medicaid Address: Location: Louisville, KY Job Description We are currently seeking a Behavioral Health Medical Director for Aetna Better Health of Kentucky, supporting Aetna Medicaid Region 3 (Florida, Kentucky and Louisiana) as well as behavioral health coverage for any of the Medicaid plans as needed. The successful candidate will be responsible for providing clinical expertise and business direction in support of the medical management programs, including clinical review, case and quality management. The Medical Director will act as a liaison to external customers and regulatory agencies. Summary: Aetna Medicaid has a model of care: To collaborate with the people we serve to integrate physical and psychosocial wraparound services based on a bio-psychosocial understanding of our member’s lives. Essential Responsibilities: • Be committed to the Medicaid/underserved population, and to the principle that helping Medicaid members improve their health will drive lower costs and produce a return on investment for state Medicaid programs. • Be committed to promoting recovery and enhancing resiliency for all members. • Be comfortable working with data in collaboration with subject matter experts. • Provide clinical expertise and business direction in support of medical management programs through participation with clinical teams in activities of precertification, concurrent review/discharge planning, case management, disease management, quality management and clinical claim review. • Provide clinical guidance in operating effective medical management programs. • Oversee triage and referral for behavioral health staff. • Participate in quality management activities, including committee and accreditation needs. • Lead clinical staff in assuring members care is coordinated in a fashion that achieves the most value for the available benefit. • Act as a clinical liaison to state agencies and external provider community in general. • Be comfortable in working in a fast-paced, fluid, high-energy environment where all team members are accountable for creating high quality work products, where cross-functional teamwork is routine, and where rapid-cycle development is required to meet market demands. Aetna operates Medicaid managed care plans in sixteen states: Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia and West Virginia. Required Qualifications -2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. -Active and current Kentucky state medical license without encumbrances -M.D. or D.O., Board Certification in a ABMS recognized specialty including post-graduate direct patient care experience. -Experience working with individuals with serious/severe mental illness, disabling substance use disorders, or developmental disabilities, etc COVID Requirements COVID-19 Vaccination Requirement CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated. If you are 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 within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health. If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated. Preferred Qualifications Healthcare Insurance experience Managed Care experience Education -Active and current state medical license without encumbrances -M.D. or D.O., Board Certification in a ABMS recognized specialty including post-graduate direct patient care experience Business Overview At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart. We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. Apply A workplace that supports diversity, inclusion and belonging. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW (PDF) Opens in a new window and EEO IS THE LAW SUPPLEMENT Opens in a new window . Please note that we only accept applications for employment via this site. We provide reasonable accommodations to individuals with disabilities as needed. To request an accommodation – including a qualified interpreter, written information in other formats, translation or other services – please email AdviceandCounselcvshealth.com or call 877-805-9511 . If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution. The health and safety of our employees, patients, customers, and members is our top priority as we face the impact of COVID-19 together. We encourage you to visit our COVID-19 resource center to learn more. About CVS Health CVS Health is the leading health solutions company that delivers care in ways no one else can. We help people navigate the health care system — and their personal health care — by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status.