Senior Clinical Solutions Medical Director – Behavioral Health Quality Job Listing at CVS Health in Tallahassee, FL (Job ID R0229803)

Description

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. *Senior Clinical Solutions Medical Director – Behavioral Health Quality*  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.   The Senior Medical Director - Behavioral Health Quality will be responsible for the behavioral health quality clinical program across Aetna and CVS Health companies.  The role will work collaboratively to build a comprehensive quality assurance program including working with external and internal stakeholders, serve as the SME for HEDIS and other federal and state quality requirements.  This role will identify and work collaboratively across the enterprise to close policy gaps.    * Create infrastructure for newly implemented BH quality assurance program based on standards of care, federal and state regulations, and parity requirements and will create and recommend workflows for QA initiatives   * The successful candidate will provide subject matter expertise across the enterprise for quality initiatives.   * Overall accountability for quality assurance audits and oversite of QA team  * Interface directly with internal and external stakeholders around quality and safety initiatives as well as practice improvement recommendations  * Provide clinical leadership to quality initiatives across CVS Health  * Ensures processes are compliant with all Federal and State regulations.  * Serves as a clinical SME for quality assurance Managers, and Directors as well as with PQOC, NCQA and HEDIS teams  * Functions as clinical SME in the creation of data analytic monitors to identify and support quality initiatives.  * Work collaboratively with numerous internal stakeholders  * Demonstrated ability to make strategic decisions based on a thorough understanding of industry issues, trends and the regulatory landscape.  * Exhibits behaviors as outlined in Employee Competencies  *Required Qualifications:*  * Ten (10) or more years of experience post residency/ fellowship  * Three (3) or more years of experience in Quality Management  * Three (3) or more years of supervisory experience  * M.D. or D.O., Board Certification in psychiatry * Active and Unencumbered license to practice medicine   * Knowledge of pertinent policies and procedures related to claims payment of healthcare related services.     *Preferred Qualifications:*  * Prefer extensive managed care experience  * Psychiatric experience using clinical expertise in reviewing medical records for all levels of care   * Psychiatric experience in providing clinical guidance and input in the business analytic building process.   * Willingness to seek appropriate Medical Licensure in states as needed/required     *Education:*  * Active and current state medical license(s) without encumbrances   * M.D. or D.O., Board Certification in psychiatry, including 5 years of post-graduate direct patient care experience.    *Pay Range* The typical pay range for this role is: $184,112.50 - $396,600.00 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 [jobs.CVSHealth.com/benefits](https://jobs.cvshealth.com/benefits) We anticipate the application window for this opening will close on: 06/24/2024