Child Welfare Leader

Job DescriptionAetna Better Health of Florida (ABH-FL) is searching for a Leader of a new line of business serving the Child Welfare population. The right candidate will help to build the program, drawing on the best of ABH's program expertise in other states; participate in the bid & negotiation for a CW state contract; and, having secured the business, direct & oversee ABH-FL's ongoing management of this population. In so doing, this leader will successfully establish ABH-FL as a full partner to the entities in Florida's child welfare system, including the state Department of Children and Families (DCF), law enforcement and other agencies, the courts, service providers, and local communities and organizations. As the leader of the Child Welfare line of business, you will report to the ABH-FL CEO and become a key member of the health plan's leadership team. You will have the leadership presence and networking skills that allow you to work effectively in a corporate matrix environment as well as with state agencies and regulators and other stakeholders. This includes excellent communication and presentation skills, as well as the self-motivation to learn and stay current with the social & political environment impacting the CW line of business. You will have existing experience in health plan operations, new program development and implementation, and process improvement. You will develop, implement, support, and promote the Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to the CW population. You will collaborate with executive leadership throughout the ABH organization to develop and implement program strategies that meet business, CMS, federal and state regulations as well as accrediting agency requirements. You will create and maintain collaborative partnerships with key partners and providers; work to establish collaborative relationships by fostering excellent customer response and appropriate problem resolution You will lead the team that promotes high standards of operational practice through advancement of policies, procedures, practice guidelines and alignment of clinical and business processes and practices You are responsible for cross-functional integration of care and case management, utilization management, program operations with core organization-wide business functions including claims, member services, compliance, quality and network/provider services You are responsible for cost savings and quality improvement projects through successful implementation. You will Lead and manage all aspects of projects and/or programs; Ensure the use of a formal project plan and collaborative workgroups are used in demonstrating the achievement of the project implementation goals. You will consult and support the utilization management processes by encouraging the use of industry best practices and standards. You are responsible for relationship management for vendors; ensure targets are achieved and medical management goals are met. Knowledge of medical management regulations, standards, and policies You must have established relationships in the Florida behavioral health in communityRequired Qualifications 7+ years of experience in managed care 5+ years management or clinical leadership 5+ years clinical practice experience in physical or behavioral healthcare 5+ years MedicaidCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications 5+ years interacting with Florida managing entities, community based organizations and Behavioral Heath providers, familiarity with DOJ/Juvenile justice, and guardianship programs.EducationMaster's degree in behavioral health field; or Registered Nurse - BH experience (Masters preferred) Active unrestricted State Licensure in applicable functional area. (e.g. RN, LPC, LCSW)Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-10-04