Lead Director, Behavioral Health – Specialty Programs

This is a fully remote position, open to applicants in Florida.

📋 Description

• Oversee strategy, implementation, and performance for Florida Medicaid and Florida Healthy Kids behavioral health and specialty populations.

• Concentrate on children and adolescents with intricate behavioral health requirements.

• Integrate clinical and business operations effectively.

• Enhance partnerships with providers and the community.

• Promote quality and population health outcomes.

• Ensure adherence to AHCA & FHKC, contractual, accreditation, and federal standards.

• Create and implement a cohesive Florida Medicaid behavioral health and specialty-population strategy.

• Lead initiatives for children in child welfare, those with complex conditions, members with serious mental health issues or substance use disorders, and other high-risk groups.

• Coordinate functions such as care management, utilization management, pharmacy, LTSS, quality, claims, member services, compliance, and network operations.

• Utilize claims, authorization, pharmacy, HIE, care management, and provider data to pinpoint gaps and prioritize interventions.

• Enhance access, engagement, follow-up, readmission rates, emergency department utilization, medication adherence, and address health-related social needs.

• Collaborate with Quality and VBC teams to improve outcomes in behavioral health.

• Act 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 regarding clinical effectiveness, member impact, operational performance, scalability, and return on investment.

• Track utilization, costs, and service trends across behavioral health and specialty programs.

• Partner with Compliance, SIU, and Payment Integrity to address issues related to fraud, waste, abuse, billing, authorization, and program integrity.

• Represent the health plan to AHCA, DCF, Managing Entities, providers, community organizations, and industry stakeholders.

• Assist with regulatory inquiries, audits, required reporting, and state procurements.

• Report directly to the Health Plan CEO and collaborate closely with Behavioral Health Medical Directors.

⛳️ Requirements

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

• A minimum of five years in leadership positions.

• Proven experience working with vulnerable or complex populations in both clinical and business roles.

• In-depth knowledge of Florida Medicaid behavioral health, child welfare, services for complex children, funding, delivery systems, and provider networks.

• Experience in leading cross-functional program implementation, performance enhancement, provider engagement, and regulatory compliance.

• Demonstrated capability to leverage data for setting priorities, problem-solving, and achieving measurable outcomes.

• Excellent communication, stakeholder management, and change leadership skills at the executive level.

• Willingness and capacity to travel 20-30% as necessary.

• Residence in the state of Florida is mandatory.

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

• Additional resources supporting physical, emotional, and financial well-being.