Medical Director - Behavioral Health, Aetna Medicaid

We’re looking for a Behavioral Health Medical Director to bring clinical expertise, strategic insight, and a heart for whole-person care to our high-performing team.

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This is an incredible opportunity to:

✅ Drive innovation in behavioral health delivery

✅ Lead quality, utilization, and value-based care initiatives

✅ Collaborate across clinical, operational, and community partners

✅ Shape the future of integrated Medicaid behavioral health

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💼 If you or someone in your network is looking for a meaningful leadership role with measurable impact, take a look at the full job posting below.

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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
• Provide comprehensive behavioral health care management to facilitate delivery of appropriate quality care and improve program/operational efficiency involving clinical issues
• 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
• Participate in the development, implementation, and evaluation of clinical/medical programs
• 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
• Provide psychiatric leadership for NCQA-compliant clinical quality improvement activities in collaboration with clinical and quality improvement staff
• 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.