Lead Director, Behavioral Health & Specialty Programs

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

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.

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

$100,000.00 - $231,540.00

Benefits

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.