Aetna Medical Director - Behavioral Health in Richmond, Virginia
Req ID: 50692BR
Aetna Better Health of Virginia, Inc. (ABHVA) is hiring a Psychiatrist to be the Medical Director, for our Behavioral Health (BH) and Substance Abuse (SA) Integrated Care Program for Medicaid and Long Term Systems and Supports members within the Commonwealth. You will implement and supervise delivery and coordination of all Behavioral Health and Substance Abuse services and benefits under the contract between Aetna Better Health (ABH), the Virginia Department of Medical Assistance Services, and CMS. DMAS stated, Virginia envisions a Medicaid delivery system where high value care is the norm and even the most medically complex enrollees with significant behavioral, physical, sensory, and developmental disabilities can live safely and thrive in the community.
ABHVA shares this vision to create a transformational system supporting all MLTSS members, with the highest quality care in the least restrictive environment manner. Integrated Care Management accomplishes this objective by integrating physical and behavioral health, addressing social determinants of health, and minimizing the complexity and fragmentation of services. Fundamental to the Fully Integrated System of Care and Integrated Care Management is ongoing collaboration and alignment among all internal and external stakeholders.
We will provide Relocation Assistance for the ideal candidate if needed for this position.
In this role you will:
Provide collaborative oversight for medical and BH/SA policy implementation and utilization management services.
Participate in the development, implementation, and evaluation of clinical/medical programs.
Provide behavioral health leadership, oversight and consultation for the QI and UM programs including development, implementation, evaluation and compliance.
Oversee the behavioral health utilization review process and oversee the quality of utilization determinations.
Ensure compliance with clinical goals through monitoring care management performance.
Develop, implement and interpret BH/SA medical policy including medical necessity criteria, clinical practice guidelines and new technology assessments.
Promote the Bio-Psycho-Social model for integrated care management.
Supply expertise to the management and authorization of services for Traumatic Brain Injury (TBI).
Under the direction of the Chief Medical Officer (CMO), Review BH/SA prior authorizations for medical necessity.
Under the direction of the Chief Medical Officer (CMO) recruit, train, supervise and evaluate the quality of medical staff and any physician advisors.
Participate regularly in the Interdisciplinary Care Management Rounds.
Serve as a subject matter expert and liaison with State Medicaid and CMS leadership for behavioral health and substance abuse issues.
Coordinate collaborative relationships with Community Mental Health Centers (CMHCs), Federally Qualified Healthcare Clinics (FQHCs) and various Advocacy Groups.
2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
The highest level of education desired for candidates in this position is an MD or DO.
Utilization review and accreditation (NCQA, AAHCC/URAC) experience preferred.
Medical Degree (MD or DO) from accredited (ACME or AOA) American or Canadian medical school or equivalent training in a foreign medical school with successful completion of ECFMG and FLEX exams.
Full training in a ACGME approved U.S. or Canadian residency program.
MBA, MHA, MPA or advanced management training a plus.
LICENSES AND CERTIFICATIONS:
Board Certification, Psychiatry is required
Active unrestricted License to practice Medicine in the state of Virginia is required or ability to obtain a license in the state of Virginia.
5-8 years of experience involving substantial direct BH and SA patient care at multiple levels of care.
Experience with Medicaid and Medicare policies and regulations.
Managed care experience, as provider and manager of care.- Direct patient care in Behavioral Health and Substance Abuse.
Managed Care Experience as a BH/SA Medical Director preferred
Experience with trauma informed care and maximizing the use of peer specialists and community mental health workers preferred
Knowledge and experience in providing and or coordinating Mental Health(BH) and (SA) services under Rule 132.
Experience in interacting with Community Based Mental Health Centers (CMHC).
Familiarity with BH and SA Networks in the Virginia area preferred but not required.
Experience in interacting with various BH and SA and other Aged, Blind and Disabled (ABD) Advocacy Groups is a plus.
Benefits Management: Interacting with Medical Professionals and Maximizing Healthcare Quality
Service: Improving constituent-focused Processes
Leadership: Collaborating for Results and Driving a Culture of Compliance
General Business: Maximizing Work Practices
Mostly office based in Richmond. Open to part-time telework or work at other Virginia Regional Offices
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
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Job Function: Health Care