Lead Director, Behavioral Health & Specialty Programs

4004 Aetna Medicaid Administrators; Florida; Hybride; USD 100 000 - 232 000; Plein temps

Avantages offerts par ce poste

Bonus eligibility

Résumé du poste

CVS Health seeks a Lead Director to shape and execute Florida Medicaid and children’s behavioral health and specialty programs. The role integrates clinical and business operations, strengthening providers and partnerships to improve access, quality, and outcomes within a complex care landscape.

You’ll lead cross-functional teams, drive program strategy, ensure regulatory compliance, and report to the Health Plan CEO. This is a full-time Florida-based leadership opportunity.

Qualifications

• 10+ years in Medicaid managed care, behavioral health, healthcare operations, or population health.
• Experience leading cross-functional program implementation and regulatory compliance.
• Residence within the state of Florida.

Responsabilités

• Lead development and implementation of Florida Medicaid behavioral health and specialty programs for children and adolescents with complex needs.
• Coordinate care management, utilization management, pharmacy, LTSS, quality, claims, member services, and network functions.
• Use data from claims, authorizations, pharmacy, and care-management systems to identify gaps and drive improvements in access, engagement, and outcomes.
• Partner with Quality and VBC teams to improve behavioral health outcomes and readmission metrics.
• Oversee BH vendors and providers for clinical effectiveness, ROI, and program integrity.

Connaissances

Medicaid managed care

Behavioral health

Data-driven decisions

Stakeholder management

Executive communication

Travel 20-30%

Formation

Bachelor’s degree

Description du poste

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary 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 BH needs. Reporting to the Health Plan CEO and working closely with Behavioral Health Medical Directors, this role integrates clinical and business operations, strengthens providers and community partnerships, advances quality and population health outcomes, and ensures compliance with AHCA & FHKC, contract, accreditation, and federal requirements. 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.

Key Responsibilities

• 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, such as 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 drive strategies and improve adequacy, appointment availability, specialty capacity, provider performance, and value-based arrangements.
• Oversee BH vendors and providers for clinical effectiveness, member impact, operational performance, scalability, and return on investment.
• Monitor utilization, cost, and service trends across BH and specialty programs; partner with Compliance, SIU, and Payment Integrity to address fraud, waste, abuse, and 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.

Required Qualifications

• 10+ 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.

Preferred Qualifications

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

Education

• Bachelor’s degree in behavioral health, social work, psychology, nursing, healthcare administration, public health, or equivalent work experience.

Pay Range

The typical pay range for this role is: $100,000.00 - $231,540.00 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.

We anticipate the application window for this opening will close on: 12/08/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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.

Our Work Experience

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.