Medical Director - Behavioral Health, Aetna Medicaid

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary 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 position will primarily support the Medicaid plans for Kentucky and Louisiana but be expected to fill in for other states needed. Work at Home with Central Standard Time hours expected. • *This is a remote-based (work from home) role.** In this role as Medical Director (Behavioral Health), you will: • 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 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 • 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 triage and referral for care management • Provide weekend coverage every 6-7 weeks. • Perform other duties as deemed necessary. Required Qualifications • Board Certification in Psychiatry • Active and current state medical license without encumbrances, and ability to obtain other state licenses. Preferred Qualifications • 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 or DO 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. 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. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit We anticipate the application window for this opening will close on: 02/13/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply tot his job