Remote-Based Behavioral Health Medical Director

Job Overview

Aetna Better Health of Louisiana is seeking a dedicated and experienced Behavioral Health Medical Director. The Behavioral Health Medical Director will ensure timely medical decisions, including after-hours consultation, and will share responsibility for managing the behavioral health services delivery system.

Key Responsibilities

• Participation in the development of clinical practice standards, policies, and procedures.

• Participation in state led meetings with other medical directors and behavioral health MCO stakeholder meetings and other agency/stakeholder meetings when requested.

• Oversight and implementation of the utilization management program for behavioral health services, including monitoring for over/under-utilization.

• Ensuring consistency in the application of utilization management standards, including those implemented by subcontracted entities for BH services.

• Overseeing the complaint and grievance process for behavioral health denials, including state fair hearings and external review organizations.

• Review and resolution of quality-of-care concerns.

• Serve as the subject matter expert on behavioral health for ABHLA, ensuring compliance and alignment with state regulations and expectations.

• Lead and coordinate efforts with the state and other health plan colleagues to promote integrated care models.

• Oversee coordination activities with the state, ensuring effective collaboration and adherence to regulatory requirements.

• Work closely with health plan leadership, the Chief Medical Officer, other Medical Leadership, Pharmacy Director, clinical staff (including those in utilization management, care management, quality management), and colleagues within network and provider relations, to enhance the delivery of holistic and integrated care.

• Contribute to the development and implementation of policies and procedures that support the health plan's objectives and comply with state guidelines.

• Advocate for and implement innovative approaches to behavioral health care, promoting evidence-based practices that enhance patient outcomes.

• Support duties as required regarding utilization management of the service benefit and pharmacy benefit within the state health plan and additional duties as assigned.

Required Qualifications

• Board-certified in Psychiatry.

• Louisiana Residency

• Current, unencumbered medical license from the Louisiana State Board of Medical Examiners.

• At least three (3) years of training in a medical specialty.

• Experience in managing behavioral health services and working with multiple child- serving systems.

• Strong leadership and communication skills.

• Ability to attend in-person meetings and manage after-hours consultations when needed.

Preferred Qualifications

• Previous UM Experience with a Health Plan or Health / Hospital System

Education

• MD or DO