Behavioral Health Medical Director Texas

2 weeks ago

Austin, United States CVS Health Full time

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

**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.

**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.
- 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.
- 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.

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