Note: The job is a remote job and is open to candidates in USA. The California Mental Health Services Authority (CalMHSA) is a government entity serving California's county-based behavioral health system of care, which provides a wide range of mental health and substance use disorder services. The QA/QI Clinician – QA & Compliance is designed for licensed behavioral health professionals with expertise in quality assurance and compliance, supporting California's county behavioral health plans by interpreting complex clinical and regulatory requirements.
Responsibilities
- Lead and support quality assurance, compliance, utilization management, quality improvement, and other clinical and operational initiatives that support California county behavioral health plans (BHPs)
- Conduct clinical documentation reviews, quality audits, and program audits to evaluate compliance with federal, state, contractual, and organizational requirements
- Monitor quality and performance measures, establish key performance indicators, analyze data and trends, and develop recommendations to improve clinical quality, compliance, and operational performance
- Develop, implement, monitor, and evaluate quality improvement initiatives using data-driven methodologies and continuous quality improvement principles
- Develop and maintain clinical resource guides, documentation manuals, policies, procedures, implementation tools, and other operational resources that support county behavioral health programs
- Interpret federal and state behavioral health laws, regulations, contractual requirements, and guidance, and translate them into practical operational recommendations, policies, workflows, and implementation strategies
- Develop and deliver behavioral health training programs, educational materials, and presentations related to quality assurance, compliance, utilization management, documentation, and regulatory requirements
- Provide technical assistance and implementation support to county behavioral health plans related to quality, compliance, documentation, regulatory changes, and operational best practices
- Manage multiple projects and competing priorities while meeting established timelines and maintaining high-quality deliverables
- Maintain current knowledge of behavioral health laws, regulations, contractual requirements, and industry best practices to ensure compliance and support organizational objectives
- Collaborate effectively with county behavioral health plans, state agencies, vendors, providers, and internal multidisciplinary teams to advance quality and compliance initiatives
- Identify opportunities to improve processes, enhance operational efficiency, and implement innovative solutions that strengthen quality, compliance, and service delivery
- Perform other duties as assigned, demonstrating flexibility and commitment to organizational success
Skills
- Current, active, and unrestricted California clinical license as an LCSW, LMFT, LPCC, Psychologist (PhD/PsyD), or other equivalent California behavioral health clinical license is required
- Minimum of three (3) years of experience performing quality assurance, quality improvement, utilization management, compliance, or related quality oversight activities within California's public behavioral health system (i.e., county BHPs)
- Demonstrated knowledge of Department of Health Care Services (DHCS) regulatory requirements, county BHP operations and clinical documentation standards is required
- Demonstrated ability to manage multiple priorities, organize complex workstreams, and consistently meet deadlines while maintaining a high level of accuracy and attention to detail
- Experience supporting behavioral health quality assurance, quality improvement, utilization management, compliance, and/or policy implementation initiatives
- Strong written and verbal communication skills, including the ability to synthesize complex clinical, operational, and regulatory information into clear, actionable guidance for diverse audiences
- Strong analytical and critical thinking skills, with the ability to identify issues, evaluate options, and recommend practical solutions
- Ability to interpret and apply federal and state behavioral health laws, regulations, policies, and guidance, and translate regulatory requirements into operational recommendations and practical implementation strategies
- Demonstrated initiative, sound judgment, and a proactive approach to problem-solving and continuous improvement
- Ability to build effective working relationships and collaborate successfully with multidisciplinary teams, county partners, vendors, and internal stakeholders
- Ability to communicate and work effectively with individuals at all organizational levels and with varying levels of technical and clinical expertise
- Demonstrated proficiency with Microsoft Office Suite and the ability to quickly learn new technology platforms and software applications
- Demonstrate the ability to use a computer and applicable computer software effectively
- Intermediate knowledge of Excel & Word, PowerPoint, Adobe, and Outlook
- Demonstrate the ability to read, comprehend, and respond appropriately through written or verbal form; demonstrate tactfulness when communicating, including internal communication with staff members of all levels; ability to communicate with a variety of audiences effectively
- Ability to add, subtract, multiply, and divide in all measure units, using whole numbers, common fractions, and decimals
- Demonstrate the ability to effectively apply common sense and follow through to daily tasks; demonstrate the ability to work with little or no supervision; demonstrate excellent analytical and critical thinking skills; demonstrate the ability to efficiently conduct research and ask appropriate probing questions to complete necessary tasks
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