Dr. Caroline Carney MD, MSc, FAPM, CPHQ

Chief Medical Officer, Magellan Health

Phoenix, AZ

2

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About

Dr. Carney is a board-certified internist and a board-certified psychiatrist and executive with strategic clinical leadership experience, serving as chief medical officer for Magellan Health and MagellanRx Management. In this key leadership role, Dr. Carney advances Magellan Health’s clinical mission and further position the company’s significant leadership capabilities in clinical engagement. She also serves as the chief medical officer of Magellan Rx Management, leading the development and implementation of innovative, integrated clinical programs for customers and members of Magellan’s pharmacy business segment. She previously served as the senior vice president and chief medical officer for Behavioral Health and Specialty Medicine of Magellan Healthcare. Dr. Carney also served as chief medical officer for Magellan Complete Care of Arizona. Prior to Magellan, Dr. Carney’s distinguished clinical and professional experiences include serving in a variety of chief medical officer roles working with Medicare, Medicaid, commercial (private) and Marketplace populations and programs. Dr. Carney also served as the medical director for the state of Indiana Office of Medicaid Policy and Planning and helped launch the state’s early Medicaid expansion products and its mental health transformation initiatives. Dr. Carney currently serves on the Opioid Technical Expert Panel (TEP) assembled by the NQF pursuant to the Substance Use Disorder Prevention that Promotes Opioid Record and Treatment for Patients and Communities Act (Pub. L. 115‐271), and the Mental Health and Substance Use Measure Development TEP under the American Psychiatric Association’s cooperative agreement with the Centers for Medicare & Medicaid Services. She also has served on a variety of national and state committees, including the NQF’s Measure Incubator for Appropriate Pain Management Strategy Expert Panel; NQF’s National Quality Partners™ Opioid Stewardship Action Team; NQF’s Behavioral Health Measures Committee; and, Governor’s Mental Health Commission. She also has had an extraordinary clinical research and teaching career with various academic appointments.

Ask me about
behavioral health
Internal Medicine
digital therapeutics
mental health
collaborative care
quality
case management
care management
utilization management
Pursue Care
Eleanor Health
Quit Genius
Work experience

Jun 2020 - Present

Magellan Health

Chief Medical Officer, Magellan Health

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Sep 2018 - Present

Magellan Rx Management

Chief Medical Officer

Currently working with a talented team to build differentiated, industry-leading clinical programs and services that strive to lead humanity to healthy, vibrant lives. In this role, she is broadly responsible for supporting MagellanRx in developing differentiated, industry‐leading clinical pharmacy programs and services, and for leading the division’s clinical mission, vision and product innovation. Dr. Carney also served as chief medical officer for Magellan Complete Care of Arizona, where she led Magellan’s behavioral health and medical initiatives and programs serving the Arizona Health Care Cost Containment System (Medicaid).

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Sep 2016 - Sep 2018

Magellan Healthcare

Senior Vice President & Chief Medical Officer

Responsible for supporting Magellan in developing and supporting the clinical mission, vision, products and strategies—both behavioral and specialty. Current duties include strategic development of behavioral health and medical programs and products, such as opioids and chronic pain endeavors, oversight of medical director quality and performance, and data analytic design and interpretation with clinical translation for clinical, quality, VBP, workflow, and other outcomes. I oversee the national policy and clinical guidelines team that is responsible for creating and maintaining Magellan's proprietary guidelines. I am forward facing with sales and account executive teams. Closely working with Magellan's government affairs teams, I influence Magellan and public policy for opioids, utilization management, parity, and pharmacy. I work closely with our innovations team in creating programs that incorporate the use of digital technologies into clinical care.

Jun 2015 - Aug 2016

Tenet Health Plans

Chief Medical Officer

Led development of Tenet Health Plans in AZ, TX, MI. Oversaw all clinical areas, including case management, quality improvement, disease management, and utilization management. Covered populations included Medicaid, Duals, Medicare Advantage, and Exchange. Oversaw pharmacy program, psychopharmacology quality interventions, and led teams working on 5-star and HEDIS initiatives.

Jun 2010 - Jun 2015

MDwise, Inc. and MDwise Marketplace

Chief Medical Officer

Chief Medical Officer for managed care health plan and delivery system model serving Indiana's Medicaid program including Hoosier Healthwise, Healthy Indiana Plan (HIP), and Care Select. Served the Healthcare Marketplace. CMO role oversaw quality, case management, disease management, utilization management, policy development, public facing roles, leadership in accreditation activities (NCQA), and interaction with state government officials.Oversaw pharmacy program, including selection of PBM, psychopharmacology quality interventions, and led teams working on HEDIS initiatives.

Aug 2007 - May 2010

Indiana Office of Medicaid Policy and Planning

Chief Medical Officer

Directed Healthcare outcomes, evaluation, research, and quality; liaison to other agencies including mental health, aging, and development disability; designed and implemented state’s mental health transformation with mental health division; created and implemented value-based performance program for MCE’s; redesigned medical review team for disability determinations, redesigned approach to traumatic brain injury.

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Oct 2003 - Aug 2007

Indiana University School of Medicine

Associate Tenured Professor of Internal Medicine and Psychiatry

Award winning clinician, researcher and educator for Departments of Internal Medicine and Psychiatry, grant-funded researcher (how much??) at the interface of behavioral health and physical health delivery of services; developed and implemented psychosocial oncology program, including administrative and clinical services.

2001 - 2007

Wellmark Blue Cross and Blue Shield of Iowa and South Dakota

Behavioral Health Director

Reported to CMO to serve in medical policy, accreditation, credentialing, quality, and special products for 1.5 million lives.

Jun 1999 - Jul 2003

University of Iowa Roy J. and Lucille A. Carver College of Medicine

Assistant Professor

Clinical and research award winning clinician, educator, and researcher; directed Medical Psychiatry residency program, co-director of innovative inpatient med/psych unit, consultation liaison psychiatrist; course director for school of public health’s psychiatric epidemiology program; faculty senate.

Board Certified

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