Clinical Services Manager – DMC – ODS

This is a fully remote position, open to applicants in California.

📋 Description

• Provide clinical leadership for CalMHSA’s multi-county Drug Medi-Cal Organized Delivery System (DMC-ODS) administrative model.

• Act as the designated Compliance Officer, holding organization-wide responsibility for HIPAA, 42 CFR Part 2, DMC-ODS regulatory, and contractual compliance.

• Oversee clinical quality management, utilization management, and provider compliance functions.

• Manage Quality Management Clinician(s) and Quality Management Analyst(s), including hiring, training, workload management, performance evaluations, and professional development.

• Lead responses to DHCS audits, EQRO reviews, readiness reviews, and other oversight activities, including the development of corrective action plans and evidence of completion.

• Direct clinical policy and utilization management, which includes the development of policies, procedures, and practice guidelines.

• Supervise service authorization, reauthorization, medical necessity reviews, and delegated review activities.

• Oversee the quality improvement program, which includes 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, directing investigation, escalation, and remediation efforts.

• Address compliance concerns and privacy/security incidents in collaboration 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.

• Collaborate 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.

• Ensure confidentiality and system integrity for consumer demographic and behavioral health data.

• Carry out other duties as assigned.

⛳️ Requirements

• A Master’s degree in Social Work, Marriage and Family Therapy, Professional Clinical Counseling, Psychology, or a related clinical field is required.

• A current California Board of Behavioral Sciences (BBS) licensure is necessary; acceptable credentials include LMFT, LCSW, LPCC, or equivalent independent clinical licensure recognized by the BBS.

• A minimum of 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.

• Extensive 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, with knowledge of HIPAA and 42 CFR Part 2 compliance.

• Background in working within or directly with a County Behavioral Health Plan, particularly in overseeing DMC-ODS clinical, quality, or compliance functions.

• Proven 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 understanding of HIPAA, 42 CFR Part 2, and relevant 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 stipulations.

• Demonstrated ability to conduct clinical quality reviews, analyze clinical data, and identify trends, gaps, and opportunities for improvement.

• Proven leadership and supervisory capabilities.

• Strong project management and organizational skills.

• Excellent written and verbal communication skills.

• Strong facilitation and stakeholder management abilities.

• Strong analytical, organizational, and problem-solving skills.

• Comfortable and self-motivated while working in a remote environment.

• Intermediate proficiency in Excel, Word, PowerPoint, Adobe, and Outlook is required.

• Experience with electronic health records, utilization management platforms, provider management systems, or data/reporting systems is preferred.

• Ability to manage confidential information in accordance with HIPAA, 42 CFR Part 2, state confidentiality requirements, and CalMHSA security policies.

• Availability to work regular company business hours, 8:00 AM to 5:00 PM, Monday to Friday, with a schedule that may vary based on business needs.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and continuous learning.

• Supportive work environment with a focus on employee well-being.