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Position Summary

The Behavioral Health Medical Director is a key position on Aetna Better Health of TX’s (ABHT) leadership team and is responsible for

• Leadership and counsel for utilization management

• Leadership and participation in case management programs for mental health and substance use disorder services

• Collaboration with Texas Health and Human Services, state agencies, providers, and key community partners to oversee the quality of the ABHT BH program and the implementation of BH integration efforts

• Behavioral Health executive clinical lead for ABHT, participating in market leadership and strategy meetings

The Behavioral Health Medical Director will report to the Senior Medical Director for Clinical Solutions and will work in close partnership with the ABHT CMO, COO, CEO, CFO, and all matrixed growth partners to effectively manage behavioral health benefits and care.

Successful candidate must live in Texas or be willing to relocate.

Responsibilities:

• Participation in the development of clinical practice standards, policies, and procedures.

• Behavioral health care management performance and coordination with physical health care management.

• Participation in HHS medical director and behavioral health MCO stakeholder meetings and other agency/stakeholder meetings when requested.

• Oversight and implementation of the utilization management program for behavioral health services, including monitoring for over/under-utilization.

• Ensuring consistency in the application of utilization management standards, including those implemented by subcontracted entities for BH services.

• Overseeing the complaint and grievance process for behavioral health denials, including state fair hearings and external review organizations.

• Review and resolution of quality-of-care concerns.

• Participation in clinical staff recruitment and ongoing performance improvement.

• Provide strategic oversight and leadership for all behavioral health activities within the health plan.

• Serve as the subject matter expert on behavioral health for ABHT, ensuring compliance and alignment with state regulations and expectations.

• Lead and coordinate efforts with the state and other health plan colleagues to promote integrated care models.

• Oversee coordination activities with the state, ensuring effective collaboration and adherence to regulatory requirements.

• Work closely with health plan leadership, the Chief Medical Officer, other Medical Leadership, Pharmacy Director, clinical staff (including those in utilization management, care management, quality management), and colleagues within network and provider relations, to enhance the delivery of holistic and integrated care.

• Contribute to the development and implementation of policies and procedures that support the health plan's objectives and comply with state guidelines.

• Advocate for and implement innovative approaches to behavioral health care, promoting evidence-based practices that enhance patient outcomes.

• Support duties as required regarding utilization management of the service benefit and pharmacy benefit within the state health plan and additional duties as assigned.

• Actively participate in continuous improvement activities, development and monitoring of SAI initiatives, and other activities that support quality of care and total cost of care oversight.

• Serve as a key health plan external facing liaison, regarding behavioral health initiatives, programs, and projects with state regulators, providers, vendors, and community organizations.

Required Qualifications:

• Must reside in TX

-Significant clinical experience in the treatment of substance use disorders, including utilization of ASAM criteria, and an understanding of the Texas system of care.

• At least five years combined experience in mental health and substance use services and at least two (2) years of BH leadership experience in a government, health management, or managed care organization, and/or at least two (2) years of experience as a Medical Director in clinical practice, and/or at least three (3) years of clinical BH experience (excluding psychiatric residency).

• Experience in perinatal mental health conditions and pediatric behavioral health conditions.

• Experience with TX Medicaid behavioral health benefits and service.

• Ability to effectively interact with providers, advocacy groups and State partners.

• Excellent organization and time management skills

• Experience navigating a matrixed organization.

• Medicaid regulatory experience

Education:

Board-certified psychiatrist licensed in the State of Texas.

Subspecialty board certification can be by the American Board of Psychiatry and Neurology (ABPN), the American Osteopathic Association (AOA), or the American Board of Preventive Medicine (ABPN).

Pay Range

The typical pay range for this role is:

$174,070.00 - $374,900.00

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 11/29/2024

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

We are an equal opportunity and affirmative action employer. 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.