QA QI Clinician

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🔥 7 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $120k - $140k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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California Mental Health Services Authority

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2009

⚕️ Healthcare Insurance

🤝 Non-profit

🏛️ Government

Healthcare Insurance • Non-profit • Government

California Mental Health Services Authority (CalMHSA) is an independent administrative and fiscal public entity representing California counties. It focuses on transforming mental health care by developing electronic health records (EHR) and promoting interoperability among various health IT systems. CalMHSA supports counties in improving mental health services through initiatives like early psychosis intervention, workforce development, suicide prevention hotlines, and research on equity and community impact. The organization works closely with county behavioral health departments to enhance support for mental health initiatives, especially in underserved communities.

📋 Description

• Support CalMHSA’s regional Drug Medi-Cal Organized Delivery System (DMC-ODS) administrative model by providing clinical leadership for quality management, utilization management, provider compliance, and care delivery oversight activities. • Conduct clinical service authorization, reauthorization, and medical necessity reviews for delegated DMC-ODS functions, including residential and withdrawal management services, as applicable. • Apply ASAM criteria, DMC-ODS requirements, Medi-Cal medical necessity standards, and parity considerations to clinical review and utilization management activities. • Provide clinical consultation on access, screening, referral, care coordination, placement, transitions between levels of care, and residential step-down planning. • Develop and review clinical policies, procedures, practice guidelines, training expectations, and clinical workflow standards for delegated DMC-ODS functions. • Provide clinical leadership for provider onboarding, implementation support, and provider-facing operations related to access, screening, documentation, care coordination, and service delivery expectations. • Oversee clinical components of provider credentialing/recredentialing standards, including review of provider qualifications, scope of services, and clinical service capacity. • Lead clinical quality improvement activities, including QI Work Plan development, PIP coordination, clinical trend review, and development of clinically informed improvement strategies. • Review utilization, access, grievance, provider performance, and quality data to identify clinical risks, gaps in care, and opportunities for improvement. • Provide training and technical assistance to counties, providers, and internal teams on DMC-ODS clinical requirements, ASAM criteria, medical necessity, documentation expectations, and care coordination standards. • Represent CalMHSA in clinical quality, utilization management, provider, county, EQRO, DHCS, and other stakeholder meetings, as assigned.

🎯 Requirements

• 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 or license eligibility required; acceptable credentials may include LMFT, LCSW, LPCC, AMFT, ACSW, APCC, or equivalent BBS-recognized status. • Minimum of five (5) years of experience in behavioral health, substance use disorder treatment, quality management, utilization management, clinical program oversight, or a closely related field, required. • Experience with DMC-ODS, including ASAM criteria, medical necessity, authorization processes, residential treatment, withdrawal management, care coordination, and Medi-Cal documentation requirements, strongly preferred. • Experience working within or directly with a County Behavioral Health Plan, particularly overseeing or supporting DMC-ODS functions, strongly preferred. • Experience with provider monitoring, credentialing/recredentialing, site reviews, chart reviews, quality improvement, EQRO, PIPs, or corrective action processes, preferred.

🏖️ Benefits

• Health insurance • Retirement plans • Flexible work arrangements • Professional development opportunities