Lead Director, Behavioral Health & Specialty Programs

CVS Health•Work At Home-Florida, FL

1d•$100,000 - $231,540

About The Position

The Lead Director, Behavioral Health & Specialty Programs leads strategy, implementation, and performance for Florida Medicaid and Florida Healthy Kids behavioral health and specialty populations, with particular focus on children and adolescents with complex behavioral health needs. Reporting to the Health Plan CEO and working closely with Behavioral Health Medical Directors, this role integrates clinical and business operations, strengthens provider and community partnerships, advances quality and population health outcomes, and ensures compliance with AHCA, FHKC, contract, accreditation, and federal requirements. The position develops and executes an integrated Florida Medicaid behavioral health and specialty-population strategy aligned with state priorities, contract requirements, member needs, and health plan goals. It coordinates across clinical, operational, network, and support functions to improve person-centered care, access, transitions, crisis diversion, referrals, and measurable health outcomes. The role also represents the health plan with state agencies, providers, community organizations, and industry partners. The position requires residence in Florida and travel of 20–30% as needed.

Requirements

10+ years of experience in Medicaid managed care, behavioral health, healthcare operations, population health, or specialty programs, including at least five years in leadership roles.
Demonstrated experience serving vulnerable or complex populations in a clinical or business capacity.
Strong knowledge of Florida Medicaid behavioral health, child welfare, complex-children services, funding, delivery systems, and provider networks.
Experience leading cross-functional program implementation, performance improvement, provider engagement, and regulatory compliance.
Demonstrated ability to use data to set priorities, solve problems, and deliver measurable results.
Strong executive communication, stakeholder management, and change-leadership skills.
Willingness and ability to travel 20–30% as needed for business meetings, stakeholder engagement, and project support.
Residence within the state of Florida is required.
Bachelor’s degree in behavioral health, social work, psychology, nursing, healthcare administration, public health, or equivalent work experience.

Nice To Haves

Established relationships with Florida behavioral health, child welfare, complex care community, and state partners.

Responsibilities

Develop and execute an integrated Florida Medicaid behavioral health and specialty-population strategy aligned with state priorities, contract requirements, member needs, and health plan goals.
Lead development and implementation of programs for children in child welfare, children with complex conditions, members with serious mental illness or substance use disorders, and other high-risk populations.
Coordinate care management, utilization management, pharmacy, LTSS, quality, claims, member services, compliance, and network functions to support person-centered care, effective transitions, crisis diversion, and closed-loop referrals.
Use claims, authorization, pharmacy, HIE, care-management, and provider data to identify gaps, prioritize interventions, and improve access, engagement, follow-up, readmissions, emergency department use, medication adherence, and health-related social needs.
Partner with Quality and VBC teams to drive measurable improvement in behavioral health outcomes, including BH readmissions, Follow-Up after ED visit for Substance Use (FUA), and Follow-Up after ED visit for Mental Illness (FUM).
Serve as a subject-matter expert and relationship leader for key providers; partner with network teams to improve network adequacy, appointment availability, specialty capacity, provider performance, and value-based arrangements.
Oversee behavioral health vendors and providers for clinical effectiveness, member impact, operational performance, scalability, and return on investment.
Monitor utilization, cost, and service trends across behavioral health and specialty programs; partner with Compliance, SIU, and Payment Integrity to address fraud, waste, abuse, billing, and authorization concerns and ensure program integrity.
Represent the health plan with AHCA, DCF, Managing Entities, providers, community organizations, and industry partners.
Support regulatory inquiries, audits, required reporting, and state procurements.