Clinical Services Manager – DMC – ODS

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🕒 4 dias atrás

🏄 California – Remoto

🏄 California – Remote

💵 $140.000 - $165.000 / ano

⏰ Tempo Integral

🟠 Sênior

🔴 Especialista

👔 Gerente

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California Mental Health Services Authority

SiteLinkedInTodas as Vagas

51 - 200 funcionários

Fundada em 2009

🏥 Saúde

💼 Consultoria

⚕️ Seguro de Saúde

Healthcare • Consulting • Healthcare Insurance

A Autoridade de Serviços de Saúde Mental da Califórnia (CalMHSA) é uma entidade pública independente de administração e fiscal representando os condados da Califórnia. Focada em transformar o atendimento de saúde mental, a CalMHSA desenvolve registros eletrônicos de saúde (EHR) e promove a interoperabilidade entre vários sistemas de saúde de TI. CalMHSA apoia os condados na melhoria dos serviços de saúde mental por meio de iniciativas como intervenção precoce em psicose, desenvolvimento da força de trabalho, linhas diretas de prevenção ao suicídio e pesquisa sobre equidade e impacto comunitário. A organização trabalha em estreita colaboração com departamentos de saúde comportamental dos condados para ampliar o suporte às iniciativas de saúde mental, especialmente em comunidades carentes.

Descrição

• Provide clinical leadership for CalMHSA’s multi-county Drug Medi-Cal Organized Delivery System (DMC-ODS) administrative model • Serve as designated Compliance Officer with organization-wide responsibility for HIPAA, 42 CFR Part 2, DMC-ODS regulatory, and contractual compliance • Direct clinical quality management, utilization management, and provider compliance functions • Supervise Quality Management Clinician(s) and Quality Management Analyst(s), including hiring, training, workload management, performance reviews, and professional development • Lead responses to DHCS audits, EQRO reviews, readiness reviews, and other oversight activities, including corrective action plans and evidence of completion • Direct clinical policy and utilization management, including policy, procedure, and practice guideline development • Oversee service authorization, reauthorization, medical necessity review, and delegated review activities • Own the quality improvement program, including the QI Work Plan, PIP coordination, clinical trend analysis, and provider compliance oversight • Monitor grievances, appeals, NOABDs, utilization, access, and provider performance data to identify risks and direct investigation, escalation, and remediation • Respond to compliance concerns and privacy/security incidents in coordination with leadership and legal counsel • Provide training and technical assistance to counties, providers, and internal teams • Represent CalMHSA in clinical quality, compliance, utilization management, provider, county, EQRO, and DHCS meetings • Partner with the Senior Program Manager/AOD Administrator on planning, budgeting, staffing, and risk management • Develop clinical and compliance training programs, reports, dashboards, and leadership briefings • Maintain confidentiality and system integrity for consumer demographic and behavioral health data • Perform other duties as assigned

🎯 Requisitos

• Master’s degree in Social Work, Marriage and Family Therapy, Professional Clinical Counseling, Psychology, or related clinical field, required • Current California Board of Behavioral Sciences (BBS) licensure required; acceptable credentials include LMFT, LCSW, LPCC, or equivalent independent clinical licensure recognized by the BBS • Seven (7) years of experience in behavioral health, substance use disorder treatment, quality management, utilization management, or compliance, including at least three (3) years in a supervisory, management, or compliance leadership role • Substantial experience with DMC-ODS, including ASAM criteria, medical necessity, authorization processes, residential treatment, withdrawal management, and Medi-Cal documentation requirements • Experience serving as, or directly supporting, a Compliance Officer, Privacy Officer, or Security Officer function, including HIPAA and 42 CFR Part 2 compliance • Experience working within or directly with a County Behavioral Health Plan, particularly overseeing DMC-ODS clinical, quality, or compliance functions • Experience managing DHCS audits, EQRO reviews, corrective action plans, and provider credentialing/recredentialing programs • Expert clinical knowledge of substance use disorder treatment, DMC-ODS services, ASAM criteria, medical necessity, and care coordination • Comprehensive knowledge of HIPAA, 42 CFR Part 2, and applicable behavioral health confidentiality, privacy, and program integrity requirements • Strong knowledge of California county behavioral health plan operations, Medi-Cal managed care requirements, and DMC-ODS contract requirements • Demonstrated ability to conduct clinical quality reviews, analyze clinical data, and identify trends, gaps, and improvement opportunities • Demonstrated leadership and supervisory skills • Strong project management and organizational skills • Excellent written and verbal communication skills • Strong facilitation and stakeholder management skills • Strong analytical, organizational, and problem-solving skills • Comfortable and self-directed working in a remote environment • Intermediate knowledge of Excel, Word, PowerPoint, Adobe, and Outlook required • Experience with electronic health records, utilization management platforms, provider management systems, or data/reporting systems preferred • Ability to handle confidential information in accordance with HIPAA, 42 CFR Part 2, state confidentiality requirements, and CalMHSA security policies • Ability to work regular company business hours, 8:00am to 5:00pm, Monday–Friday, with schedule varying according to business needs

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