Provide oversight for Behavioral Health medical policy implementation.
Participate in the development, implementation, and evaluation of clinical/medical programs supporting our BH Medicare membership and providers.
This position is considered Part Time and will be 20 hours per week.
Fundamental Components/Job Description:
Expands Aetna's medical management programs to address member needs across the continuum of care. Supports the Behavioral Health Medicare Management staff ensuring timely and consistent responses to members and providers.
Oversees BH utilization review/quality assurance, directing case management.
Provides BH clinical expertise in relation to our Medicare membership and providers.
Provides business direction in support of BH UM programs through participation in clinical team activities.
Acts as medical director clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams
Responsible for predetermination and concurrent reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise
Five (5) - Seven (7) years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
Active and current state medical license without encumbrances
M.D. or D.O., Board Certification in Psychiatry with including post-graduate direct patient care experience.
Specialized experience with Medicare membership is a plus.
MD or DO from accredited institution - Board Certified, Psychiatry & Neurology
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.
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