Medical Director (Behavioral Health Appeals)

Job DescriptionAetna Behavioral Health is looking for a board-certified psychiatrist with at least five years combined clinical experience in mental health and substance use disorder services. This physician / psychiatrist (Medical Director) will be responsible for all behavioral health appeal activities for commercial health plans, including interaction with providers; and will work closely with the Aetna behavioral health Appeals team to assure full and fair review of appeals, consistent and timely responses to members and providers; and compliance with state and federal regulations.Pay RangeThe typical pay range for this role is:Minimum: 169,000Maximum: 364,000Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required QualificationsThe Medical Director will support behavioral health appeals management transactional reviews and pharmacy appeals. This position includes weekend coverage when assigned. The Medical Director will have or acquire familiarity or experience with American Society of Addiction Medicine criteria (ASAM); Level of Care Utilization System (LOCUS); Child and Adolescent Level of Care Utilization System (CALOCUS), and Child and Adolescent Service Intensity Instrument (CASII); Aetna's Applied Behavior Analysis Medical Necessity Guide; Level of Care for Alcohol and Drug Treatment Referral (LOCATDR 3.0); Aetna Clinical Policy Bulletins; Aetna's Custodial Care Guideline.Preferred QualificationsMultiple state medical/osteopathic licensure is a plus. Managed care experience is preferred.EducationThe highest level of education required for candidates in this position is an M.D. or D.O. degree. An active and current California medical license without encumbrances is required / The Medical Director does not have to reside in the state of California as long as licensed in California.The Medical Director must be currently Board Certified in Adult and / or Child & Adolescent Psychiatry not "Board Eligible".Business OverviewBring 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-10-04