Medical Director – Behavioral Health

CVS Health Careers

. Provide leadership and day-to-day physician oversight for the utilization management team .

Posted 11/2/2026full-timeRemote • Ohio • United StatesLead💰 $174,070 - $374,920 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in psychiatric leadership and utilization management, with a strong focus on quality care, operational efficiency, and compliance with medical policies and guidelines. Proven ability to manage high-risk cases and provide comprehensive behavioral health care management.

Highest-signal resume keywords

Board-Certified PsychiatristClinical Practice ExperienceUtilization ManagementManaged Care ExperienceNCQA Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Necessity DecisionsBehavioral Health Care ManagementQuality Improvement ActivitiesClinical Practice GuidelinesMedical Policy DevelopmentTriage and Referral ManagementAdverse Event InvestigationInterdisciplinary Team LeadershipTraining and ConsultationAction Plan Evaluation

Soft Skills

LeadershipCommunicationCollaborationProblem-SolvingInterpersonal Skills

Certifications & Qualifications

MD (Doctor of Medicine)DO (Doctor of Osteopathic Medicine)Child/Adolescent Board Certification

Industry Keywords

Utilization Management TeamHealth Care DeliveryQuality of Care ConcernsState Medical LicensePhysician Advisor Experience

About the role

Key responsibilities & impact

Provide leadership and day-to-day physician oversight for the utilization management team
Manage high-risk cases and medical necessity decisions
Provide comprehensive behavioral health care management to facilitate appropriate quality care and improve operational efficiency
Participate in the appeals process, including investigation of adverse events and quality of care concerns
Provide psychiatric leadership, medical/clinical oversight, consultation, and training to an interdisciplinary utilization management team
Assist with development, implementation, monitoring, and evaluation of the utilization management program and action plan
Assist with development, implementation, and interpretation of medical policy, medical necessity criteria, clinical practice guidelines, and new technology assessments
Participate in development, implementation, and evaluation of clinical and medical programs
Confer with behavioral health practitioners regarding patients with severe, complex, or treatment-resistant illnesses
Identify and address quality-of-care concerns with providers
Provide psychiatric leadership for NCQA-compliant clinical quality improvement activities
Participate in triage and referral for care management
Provide weekend coverage every 6–7 weeks
Perform other duties as deemed necessary

Requirements

What you’ll need

Board-certified Psychiatrist currently licensed in the State of Ohio or with the ability to become licensed in the State of Ohio
Active and current state medical license without encumbrances
Ability to obtain other state licenses
Ability to get additional state licensures and provide utilization management coverage across multiple state health plans
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
MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine)
Child/Adolescent Board Certification preferred
Preferred candidate will reside in the state of Ohio

Benefits

Comp & perks

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
Other resources supporting physical, emotional, and financial well-being