[Hiring] Lead Director, Behavioral Health & Specialty Programs @CVS Health

Role Description

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.

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.

Benefits

• Comprehensive and competitive mix of pay and benefits.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.

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.