Behavioral Health Medical Director — AI Policy & Governance

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Behavioral Health Medical Director — AI Policy & Governance

Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.

Role summary: The Behavioral Health (BH) Medical Director (MD) for AI Policy & Governance provides clinical leadership to ensure artificial intelligence (AI)—including predictive models and generative AI—is designed, validated, implemented, and monitored in ways that are clinically sound, ethical, safe, compliant, and equitable.

This role partners closely with enterprise AI governance bodies and risk stakeholders to align BH AI use cases to the company’s AI Governance Policy and related AI standards (including AI risk assessment and AI training expectations).

As part of the BH Clinical Quality team, a successful candidate will partner and work closely with a team of colleagues focused on policy as well as internal and external quality assurance.

Primary responsibilities

• Clinical governance for AI in BH

  --Provide clinical oversight for AI-enabled workflows impacting BH (e.g., risk stratification, care navigation, documentation support, utilization management support)

  --Establish clinical acceptability criteria (clinical validity, safety, workflow appropriateness) and ensure appropriate clinician-in-the-loop controls where needed

  --Establish criteria for AI vendor review in partnership with critical business partners to establish viability of proposed vendor

• AI policy, standards, and risk alignment

  --Translate enterprise AI governance requirements into BH–specific guardrails, decision pathways, and clinical review checkpoints aligned to the AI Governance Policy and the AI System Risk Assessment Standard

  --Partner with governance stakeholders to ensure AI tools/use cases complete required reviews and approvals (including use-case risk assessment and any associated controls)

  --Quality, safety, and outcomes monitoring - define clinical performance measures (effectiveness, safety signals, unintended consequences) and operational KPIs for BH AI solutions

  --Establish monitoring plans for model drift, changes in clinical practice guidelines, and emerging risk signals; recommend retraining, recalibration, or retirement when appropriate

  --Establish payment policy in partnership with network partners for AI supported clinical interventions within a provider/vendor partnership

• Equity, ethics, and responsible use

  --Identify and mitigate BH–specific risks such as bias, stigma reinforcement, access inequities, and potential harms from automation

  --Ensure responsible use principles are embedded throughout the lifecycle, from concept through deployment and ongoing monitoring

  --Ensure equitable performance across populations (e.g., depending on how model was trained, training data may not always be representative), identify and mitigate algorithmic bias in care decisions; align AI deployment with organizational values and patient trust

• Data stewardship partnership

  --Collaborate with Enterprise Data & AI Governance partners to ensure behavioral health AI initiatives uphold privacy, security, and ethical data practices, and align to enterprise guardrails and support models

  --Assess data quality, design and interpret pilots, A/B testing

• Clinical enablement and change management

  --Support clinician adoption through clear clinical guidance, training expectations, and workflow integration consistent with the organization’s AI training approach

  --Partner with operational leaders to ensure AI supports (rather than disrupts) care delivery and utilization workflows

• Stakeholder leadership and cross-functional collaboration

  --Serve as a key clinical stakeholder for AI governance forums (e.g., AI Governance Board participation / representation as applicable)

  --Provide clinical leadership in multidisciplinary reviews with product, engineering, data science, compliance, legal, privacy, and security

• As part of the clinical quality team, the successful candidate will provide coverage, support and expertise to the work of the team including clinical policy and quality assurance work within Aetna BH Medical Affairs
• Exhibit behaviors as outlined in Employee Competencies
• Be available for weekend coverage up to 4 times per year

Required qualifications

• MD or DO with board certification in Psychiatry
• Active and unencumbered license to practice medicine
• 5 or more years of clinical experience post residency/fellowship
• Significant experience in BH clinical leadership (health plan, provider organization, or integrated delivery setting)
• Demonstrated experience with clinical governance, quality/safety programs, and clinical policy implementation
• Experience evaluating or implementing AI/analytics tools in healthcare (model review, validation, monitoring, clinical workflow integration)

Preferred qualifications

• Familiarity with enterprise governance processes for AI use-case approvals and risk assessments
• Background in utilization management, care management, or clinical operations support (helpful given medical director workflow expectations in some settings)
• Proven track record of embedding AI into clinical workflows and driving adoption
• Demonstrated ability to identify and scale AI-enabled clinical use cases across payor processes and relevant populations

Key competencies

• Clinical judgment in complex BH scenarios
• Risk-based decision making and comfort working within governance frameworks
• Ability to communicate clinical requirements to technical teams and translate technical tradeoffs back to clinical leaders
• Strong collaboration, influence, and consensus-building skills

Reporting & partnerships

• Reports to: BH SMD for Quality and Policy
• Partners with: VP of Mental Wellbeing; VP, Chief Psychiatric Officer; AVP, Deputy CPO; Enterprise Data & AI Governance, AI Governance stakeholders, Security/GRC, Compliance, Privacy, Legal, Product, Data Science/ML Ops

Pay Range

The typical pay range for this role is:

$174,070.00 - $374,920.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 06/12/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.