QA QI Analyst – DMC – ODS

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

📋 Description

• Assist in executing DMC-ODS requirements across access, network, utilization management, reporting, member information, and quality improvement functions.

• Oversee utilization management tracking tools, logs, and documentation files.

• Manage credentialing/recredentialing packets and updates to the provider directory.

• Gather, organize, and evaluate quality, utilization, access, grievance, provider performance, and compliance data to pinpoint trends, risks, and necessary follow-ups.

• Organize meetings, agendas, materials, notes, follow-up items, and documentation for quality management and provider monitoring.

⛳️ Requirements

• A Bachelor’s degree in Public Health, Behavioral Health, Social Work, Healthcare Administration, Public Administration, Psychology, Sociology, or a related field is required.

• A minimum of three (3) years of experience in behavioral health, substance use disorder services, quality management, utilization management, compliance, provider monitoring, program administration, data/reporting, or a closely related field is required.

• Experience with DMC-ODS, Medi-Cal behavioral health managed care, substance use disorder treatment systems, or county behavioral health plan operations is strongly preferred.

• Experience working within or directly with a County Behavioral Health Plan, especially in supporting DMC-ODS quality management, reporting, utilization management, provider monitoring, or compliance functions is strongly preferred.

• A robust understanding of DMC-ODS, Medi-Cal behavioral health managed care, county behavioral health systems, and provider compliance requirements is essential.

• Familiarity with quality management, utilization management, provider monitoring, grievances/appeals, network adequacy, timely access, and state reporting workflows is necessary.

🏝️ Benefits

• Access to various applications.

• Maintain confidentiality and integrity of systems.