QA QI Clinician

California Mental Health Services Authority

Quality Management Clinician providing clinical leadership for quality management in DMC-ODS model. Collaborating with county plans and providers to ensure service quality and compliance.

Posted 7/10/2026full-timeRemote • California • 🇺🇸 United StatesMid-LevelSenior💰 $120,000 - $140,000 per yearWebsite

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

Master’s degree in Social Work, Marriage and Family Therapy, Professional Clinical Counseling, Psychology, or related clinical field, required.
Current California Board of Behavioral Sciences (BBS) licensure or license eligibility required; acceptable credentials may include LMFT, LCSW, LPCC, AMFT, ACSW, APCC, or equivalent BBS-recognized status.
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 field, required.
Experience with DMC-ODS, including ASAM criteria, medical necessity, authorization processes, residential treatment, withdrawal management, care coordination, and Medi-Cal documentation requirements, strongly preferred.
Experience working within or directly with a County Behavioral Health Plan, particularly overseeing or supporting DMC-ODS functions, strongly preferred.
Experience with provider monitoring, credentialing/recredentialing, site reviews, chart reviews, quality improvement, EQRO, PIPs, or corrective action processes, preferred.

Benefits

Comp & perks

Health insurance
Retirement plans
Flexible work arrangements
Professional development opportunities

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Clinical Service AuthorizationMedical Necessity ReviewsASAM Criteria ApplicationProvider CredentialingQuality Improvement ActivitiesCare CoordinationBehavioral Health OversightUtilization ReviewTraining and Technical AssistanceClinical Policy Development

Soft Skills

CommunicationCollaborationProblem-SolvingLeadershipTraining

Certifications

California BBS LicensureLMFTLCSWLPCCAMFTACSWAPCC