California Mental Health Services Authority

Operations

• Under the supervision of the Senior Director of Quality Assurance and Compliance, this position performs clinical and administrative functions that support counties in quality improvement and utilization management.
• This position partners with county and contractor staff by providing training, technical assistance, and guidance to support best practices in clinical documentation, program effectiveness, continuous quality improvement, and the processes and outcomes of care.
• Lead in developing quality assurance and improvement activities.
• Support the development of regional compliance practices to regulatory requirements impacting counties.
• Lead strategic planning and implement strategies in collaboration with management team, and other key staff members.
• Perform program development and coordination work to implement and maintain a quality management program that effectively measures, assesses, and continuous improvement in the access to and quality of care/services provided to the County's mental health consumers.
• Develop and lead training initiatives, including activities as a Subject Matter Expert (SME) in areas of quality assurance, policy, and compliance that comply with local, state, and federal regulations.
• Apply and incorporate clinical best practices to training and county behavioral health support.
• Develop and present project related documents which could include reports, contracts, agreements, presentations, and other similar materials.
• Oversee and manage key contracting deliverables and key performance indicators.
• Work closely with regulatory agencies that inform county behavioral health contractual agreements.

Director of Managed Care Operations

Account Manager

• Develop and execute statewide network strategies while building and maintaining relationships with counties, providers, managed care organizations, health systems, and other partners to improve access, coordination, and resource sharing.
• Oversee provider network performance and contract effectiveness by working with counties, providers, and internal teams to improve access, maximize housing and treatment resources, address operational challenges, and optimize clinical service outcomes.
• Serve as the primary liaison between CalMHSA and external partners, leading stakeholder engagement, governance activities, and collaborative planning efforts to support statewide initiatives.
• Lead provider network management, housing and treatment resource planning, contract oversight, and network optimization efforts to ensure effective utilization of statewide behavioral health resources.
• Develop implementation and operational plans, monitor progress, track performance measures, and ensure counties and partners receive the necessary resources and support to successfully implement statewide initiatives.
• Support the design and implementation of innovative initiatives that improve statewide behavioral health coordination and outcomes.
• Monitor housing and treatment capacity and develop solutions to address system bottlenecks and service gaps.
• Develop recommendations to improve network capacity, service delivery, provider performance, and operational efficiency.
• Identify opportunities to leverage partnerships and shared resources to advance CalMHSA's strategic goals.
• Ensure accurate documentation of network activities, partnership agreements, governance decisions, and implementation progress.
• Promotes continuous improvement, automation, and data-driven decision making.
• Provide leadership, coaching, and strategic direction to assigned staff, project teams, consultants, and stakeholders.
• Perform other duties as assigned, demonstrating flexibility and commitment to organizational success.

Director of Network Strategy – System Partnerships

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

Director of Managed Care Operations

Director of Network Strategy – System Partnerships

QA QI Analyst – DMC – ODS

QA QI Clinician

QA QI Clinician – QA & Compliance