Note: The job is a remote job and is open to candidates in USA. California Mental Health Services Authority is seeking a Quality Management Analyst to support the regional Drug Medi-Cal Organized Delivery System (DMC-ODS) model. This role involves coordinating quality management, utilization management, and compliance workflows while collaborating with various stakeholders to ensure effective implementation of DMC-ODS requirements.
Responsibilities
- Maintain utilization management tracking tools, logs, and documentation files, including authorization requests, reauthorization timelines, documentation status, and follow-up items
- Coordinate credentialing/recredentialing packets and provider directory updates
- Track provider onboarding, readiness, required documentation, training completion, and operational implementation activities
- Coordinate provider site reviews, chart reviews, documentation reviews, and monitoring activities, including scheduling, materials preparation, file organization, and follow-up tracking
- Track provider findings, corrective action plans, remediation activities, due dates, and evidence of completion
- Collect, organize, and analyze quality, utilization, access, grievance, provider performance, and compliance data to identify trends, risks, and follow-up needs
- Track grievances, appeals, NOABDs, provider complaints, and related performance data to support reporting, trend analysis, and quality improvement activities
- Coordinate and track required DMC-ODS reporting workflows, including CalOMS, DATAR, TADT, 274/network adequacy, ASAM level-of-care reporting, and other state reporting requirements, as assigned
- Develop and maintain program workflows, desk guides, tracking tools, templates, training materials, and audit-ready documentation for DMC-ODS quality management and provider operations
- Monitor DHCS guidance, contract requirements, and operational changes, and help translate requirements into tracking tools, workflow updates, and implementation materials
- Support preparation for DHCS reviews, EQRO activities, audits, readiness reviews, provider monitoring, and other compliance or oversight activities
- Coordinate meetings, agendas, materials, notes, follow-up items, and documentation for quality management, provider monitoring, county coordination, and internal implementation workgroups
- Provide operational follow-up and technical assistance to providers and counties regarding documentation requirements, reporting workflows, provider monitoring, directory updates, and quality management processes
- Perform other duties as assigned, demonstrating flexibility and commitment to organizational success
Skills
- Bachelor's degree in Public Health, Behavioral Health, Social Work, Healthcare Administration, Public Administration, Psychology, Sociology, or related field, required
- Minimum of three (3) years of experience in behavioral health, substance use disorder services, quality management, utilization management, compliance, provider monitoring, program administration, data/reporting, or a closely related field, required
- Strong understanding of DMC-ODS, Medi-Cal behavioral health managed care, county behavioral health systems, and provider compliance requirements
- Knowledge of quality management, utilization management, provider monitoring, grievances/appeals, network adequacy, timely access, and state reporting workflows
- Strong organizational skills and ability to maintain detailed, accurate, and audit-ready records
- Strong analytical skills, including the ability to review data, identify trends, track issues, and summarize findings clearly
- Excellent written and verbal communication skills, including the ability to prepare reports, summaries, procedures, workflows, and training materials
- Ability to coordinate complex processes involving multiple stakeholders, deadlines, documentation requirements, and follow-up items
- Ability to interpret regulatory, contractual, and operational requirements and translate them into practical workflows and tracking tools
- Strong attention to detail and ability to identify inconsistencies, missing information, and compliance risks
- Ability to work effectively with counties, providers, state partners, internal teams, and external stakeholders
- Ability to manage multiple priorities, adapt to changing requirements, and maintain follow-through in a fast-paced implementation environment
- Demonstrated professionalism, discretion, and ability to maintain confidentiality when handling sensitive behavioral health, provider, and compliance information
- Demonstrate the ability to use a computer and applicable computer software effectively. Intermediate knowledge of Excel & Word, PowerPoint, Adobe, and Outlook required
- Demonstrate the ability to read, comprehend, and respond appropriately through written or verbal form; demonstrate tactfulness when communicating with internal staff, counties, providers, state partners, and other stakeholders
- Demonstrate the ability to effectively apply common sense, regulatory requirements, and operational judgment to daily tasks; demonstrate the ability to work independently with limited supervision; demonstrate excellent analytical and critical thinking skills; demonstrate the ability to conduct research, ask appropriate probing questions, identify risks, and develop practical solutions
- Experience with DMC-ODS, Medi-Cal behavioral health managed care, substance use disorder treatment systems, or county behavioral health plan operations, strongly preferred
- Experience working within or directly with a County Behavioral Health Plan, particularly supporting DMC-ODS quality management, reporting, utilization management, provider monitoring, or compliance functions, strongly preferred
- Experience coordinating audits, site reviews, chart reviews, credentialing/recredentialing files, provider monitoring, corrective action plans, or quality improvement activities, preferred
- Experience developing workflows, tracking tools, policies, procedures, training materials, or program implementation resources, preferred
- Experience with electronic health records, utilization management platforms, provider management systems, project management tools, or data dashboards preferred
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