QA QI Clinician- QA & Compliance

Description

The CalMHSA Way:

• Curiosity
• Innovation
• Grounded in Mission
• Ownership
• Clarity

SUMMARY:

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. Our mission is to support counties in the service of the state's most vulnerable people.

The QA/QI Clinician – QA & Compliance is designed for licensed behavioral health professionals with expertise in quality assurance, compliance, quality improvement, utilization management, and behavioral health operations. As a member of CalMHSA's QA & Compliance Team, this position supports California's county behavioral health plans by interpreting complex clinical and regulatory requirements and translating them into practical operational guidance, implementation support, training, and other resources that strengthen compliance, quality, and service delivery.

Serving as a clinical subject matter expert, the QA/QI Clinician- QA & Compliance leads and supports a variety of quality assurance, compliance, utilization management, quality improvement, and other clinical and operational initiatives. Primary responsibilities include conducting clinical audits and quality reviews; analyzing data, performance metrics, and trends to identify opportunities for continuous improvement; developing and delivering clinical training, documentation guides, implementation resources, and other educational materials; and providing technical assistance to county partners to support the implementation of regulatory requirements and operational best practices.

Success in this role requires strong clinical judgment, analytical thinking, excellent communication skills, and the ability to collaborate effectively with county partners, state agencies, vendors, and multidisciplinary teams. The ideal candidate demonstrates initiative, accountability, adaptability, and sound professional judgment; takes ownership of their work; is receptive to constructive feedback; and thrives in a fast-paced environment where priorities evolve and continuous improvement is expected.

KEY RESPONSIBILITIES include but are not limited to:

• 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.

BACKGROUND CHECK ELIGIBLE DUTIES

This position requires access to various systems and applications that house highly sensitive and confidential information, including county behavioral health records, Protected Health Information (PHI), clinical documentation, utilization review data, quality metrics, performance indicators, and compliance reports. The incumbent will access audit findings, beneficiary information, and regulatory compliance documentation for county Mental Health Plans (MHPs) and Drug Medi-Cal (DMC)/DMC-ODS Plans (i.e., BHPs). All confidential information must be handled in strict accordance with HIPAA Privacy and Security Rules, 42 CFR Part 2 substance use disorder confidentiality regulations, state and federal privacy laws, and CalMHSA security policies, ensuring that system access is used responsibly while maintaining the integrity and security of all data systems and preventing accidental or malicious misuse of confidential information.

QUALIFICATIONS

An acceptable equivalent combination of education, experience, and skill may be considered.

EDUCATION/EXPERIENCE

• 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.

SKILLS AND ATTRIBUTES

To perform this position successfully, an individual must be able to perform each essential function satisfactorily. The requirements below represent the knowledge, skills, and abilities 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.

COMPUTER SKILLS Demonstrate the ability to use a computer and applicable computer software effectively. Intermediate knowledge of Excel & Word, PowerPoint, Adobe, and Outlook.

LANGUAGE AND MATHEMATICAL SKILLS 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.

REASONING 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.

PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is frequently required to sit and stand; use phone and headset; use hands, arms, fingers to type; answer phones; write; use calculator; demonstrate strength to lift and carry materials weighing up to 10 pounds; demonstrate clear vision to read printed materials and a computer screen; hearing and speech to communicate in person and over the telephone.

SENSORY DEMANDS The incumbent must spend long hours in intense concentration. The incumbent must also spend long hours on the computer entering information that requires attention to detail and high levels of accuracy.

MENTAL DEMANDS This position operates in a dynamic environment with multiple concurrent projects, competing priorities, and frequent deadlines. Organizational priorities, initiatives, and work assignments may shift rapidly in response to emerging needs, requiring the incumbent to adapt quickly, reprioritize work effectively, and maintain productivity and accuracy under pressure. The position requires sustained analytical thinking, problem-solving, decision-making, and the ability to manage ambiguity while balancing competing demands. The incumbent must also collaborate with and communicate effectively among a wide variety of stakeholders regarding complex policy, operational, and implementation matters.

REGULAR WORK SCHEDULE Schedule varies depending on business needs; however, regular company business hours are 8 a.m. to 5 p.m., Monday – Friday.