California Mental Health Services Authority

QA Engineer

• Support the implementation of DMC-ODS requirements across access, network, utilization management, reporting, member information, and quality improvement functions
• Maintain utilization management tracking tools, logs, and documentation files
• Coordinate credentialing/recredentialing packets and provider directory updates
• Collect, organize, and analyze quality, utilization, access, grievance, provider performance, and compliance data to identify trends, risks, and follow-up needs
• Coordinate meetings, agendas, materials, notes, follow-up items, and documentation for quality management, provider monitoring

QA QI Analyst – DMC – ODS

• 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.

QA QI Clinician

• Conduct clinical audits and quality reviews
• Analyze data, performance metrics, and trends to identify opportunities for continuous improvement
• Develop and deliver clinical training, documentation guides, and implementation resources
• Provide technical assistance to county partners to support regulatory requirements

QA QI Analyst – DMC – ODS

QA QI Clinician

QA QI Clinician – QA & Compliance