Lead Director, Behavioral Health – Specialty Programs

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🔥 1 minute ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $100k - $231.5k / year

⏰ Full Time

🟠 Senior

👔 Director

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Lead strategy, implementation, and performance for Florida Medicaid and Florida Healthy Kids behavioral health and specialty populations • Focus on children and adolescents with complex behavioral health needs • Integrate clinical and business operations • Strengthen provider and community partnerships • Advance quality and population health outcomes • Ensure compliance with AHCA & FHKC, contract, accreditation, and federal requirements • Develop and execute an integrated Florida Medicaid behavioral health and specialty-population strategy • Lead 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 • Use claims, authorization, pharmacy, HIE, care-management, and provider data to identify gaps and prioritize interventions • Improve access, engagement, follow-up, readmissions, emergency department use, medication adherence, and health-related social needs • Partner with Quality and VBC teams to improve behavioral health outcomes • Serve as a subject-matter expert and relationship leader for key providers • Drive provider 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 on fraud, waste, abuse, billing, authorization, and program integrity concerns • Represent the health plan with AHCA, DCF, Managing Entities, providers, community organizations, and industry partners • Support regulatory inquiries, audits, required reporting, and state procurements • Report to the Health Plan CEO and work closely with Behavioral Health Medical Directors

🎯 Requirements

• 10+ years of experience in Medicaid managed care, behavioral health, healthcare operations, population health, or specialty programs • 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 • 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

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Award target in the company’s equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being

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