QA QI Clinician

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

📋 Description

• Assist CalMHSA in implementing the regional Drug Medi-Cal Organized Delivery System (DMC-ODS) administrative framework by delivering clinical leadership in quality management, utilization management, provider compliance, and oversight of care delivery activities.

• Perform clinical service authorizations, reauthorizations, and medical necessity evaluations for delegated DMC-ODS responsibilities, including residential and withdrawal management services, as applicable.

• Utilize ASAM criteria, DMC-ODS regulations, Medi-Cal medical necessity guidelines, and parity considerations in clinical review and utilization management tasks.

• Offer clinical consultation regarding access, screening, referral processes, care coordination, placement, transitions between care levels, and planning for residential step-down.

• Create and evaluate clinical policies, procedures, practice guidelines, training expectations, and clinical workflow standards for delegated DMC-ODS responsibilities.

• Provide clinical leadership for onboarding providers, offering implementation support, and managing provider-facing operations related to access, screening, documentation, care coordination, and service delivery standards.

• Supervise the clinical aspects of provider credentialing and recredentialing standards, which includes assessing provider qualifications, service scope, and clinical service capacity.

• Direct clinical quality improvement initiatives, encompassing QI Work Plan development, PIP coordination, clinical trend analysis, and formulation of clinically informed improvement strategies.

• Analyze utilization, access, grievance, provider performance, and quality data to pinpoint clinical risks, care gaps, and areas for enhancement.

• Deliver training and technical assistance to counties, providers, and internal teams on DMC-ODS clinical standards, ASAM criteria, medical necessity, documentation requirements, and care coordination benchmarks.

• Represent CalMHSA in clinical quality, utilization management, provider, county, EQRO, DHCS, and other stakeholder meetings, as assigned.

⛳️ Requirements

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

• Active California Board of Behavioral Sciences (BBS) licensure or eligibility for licensure is required; acceptable credentials may include LMFT, LCSW, LPCC, AMFT, ACSW, APCC, or equivalent BBS-recognized qualification.

• A 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 area is required.

• Experience with DMC-ODS, including ASAM criteria, medical necessity evaluations, authorization protocols, residential treatment, withdrawal management, care coordination, and Medi-Cal documentation standards is strongly preferred.

• Experience working within or in direct collaboration with a County Behavioral Health Plan, particularly in overseeing or supporting DMC-ODS functions, is strongly preferred.

• Familiarity with provider monitoring, credentialing/recredentialing, site evaluations, chart assessments, quality improvement, EQRO, PIPs, or corrective action processes is preferred.

🏝️ Benefits

• Health insurance

• Retirement plans

• Flexible work arrangements

• Professional development opportunities