Medical Director – Behavioral Health

This is a fully remote position, open to applicants in Virginia.

📋 Description

• Provide leadership and daily oversight for the behavioral health utilization management team.

• Manage high-risk cases and make determinations regarding medical necessity.

• Deliver comprehensive behavioral health care management to enhance quality of care and operational efficiency.

• Engage in appeals, adverse-event investigations, and address quality-of-care issues.

• Offer psychiatric leadership, consultation, and training to a multidisciplinary utilization management team.

• Develop, implement, monitor, and assess utilization management programs and action plans.

• Formulate, implement, and interpret medical policies, medical necessity criteria, clinical practice guidelines, and assessments for new technologies.

• Contribute to the development, implementation, and evaluation of clinical and medical programs.

• Collaborate with behavioral health practitioners on severe, complex, or treatment-resistant conditions.

• Address quality-of-care concerns with healthcare providers.

• Lead clinical quality improvement initiatives that comply with NCQA standards.

• Participate in triage and referrals for care management.

• Provide weekend coverage approximately every 6–7 weeks.

• Execute other duties as required.

⛳️ Requirements

• Board-certified Psychiatrist currently licensed in the State of Virginia.

• Hold an active and current state medical license in Virginia without any encumbrances.

• Capability to obtain additional state licensures and offer utilization management coverage across various state health plans.

• MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) degree required.

• Preferred minimum of 5 years of clinical practice experience as a psychiatrist.

• Experience in managed care, provider care utilization review, or physician advisor roles is preferred.

• Child/Adolescent Board Certification is preferred.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources to support physical, emotional, and financial well-being.