Are you passionate about improving the quality of care in Health and Human Services, especially in Behavioral Health? We are looking for a dedicated Quality Management Specialist to join the Quality Management Team. In this key role, you will support the development, evaluation, and oversight of our quality assurance and utilization review efforts.

Recent changes to the education and experience requirements allow us to welcome candidates from a variety of professional and educational backgrounds. If you bring curiosity, attention to detail, and strong judgment, this is your chance to drive meaningful improvements, ensure compliance, and turn data into strategies that enhance the care we provide. If you’re ready to make a difference, we want to hear from you!

Under general supervision, the Quality Management Specialist I/II supports the development, implementation, and monitoring of quality improvement processes and compliance initiatives within the Calaveras Health and Human Services Agency.

Quality Management Specialist I:

This is the entry-level position in the Quality Management series. The incumbent is expected to work independently and have a very good understanding of the functions within the assigned HHSA Division, the methodologies to perform required tasks. Responsibilities include collaboration and coordination with staff, leadership, and external stakeholders to enhance service delivery, meeting regulatory standards, and promote equitable access to care.

Quality Management Specialist II:

This is the fully qualified journey-level classification. Incumbents are responsible for the more complex and difficult technical assignments and work with greater independence. Incumbents are expected to have an excellent understanding of functions within the assigned HHSA Division and be highly skilled in all aspects. The incumbent will assist in guiding subordinates and will work with professional and technical subordinates assigned to specific programs. Incumbents are expected to be subject matter experts. This position is distinguished by lead responsibilities and level of skill and expertise.

The following duties are typical for this classification. Incumbents may not perform all of the duties listed and/or may be required to perform additional or different duties from those set forth below to address business needs and changing business practices.

• Assists in the design, implementation, and monitoring of quality assurance programs and policies to ensure compliance with federal, state, and local regulations.
• Develops and delivers training programs to enhance staff understanding of quality assurance principles and compliance requirements.
• Collects, analyzes, and reports on data related to service delivery outcomes and process improvements.
• Maintains documentation of complaints and grievances.
• Reports outcomes and other data to the State as required by contract, law or regulations.
• Monitors compliance with response timelines for access, treatment authorization requests and payment.
• Develops, updates and monitors the cultural competency plan.
• Monitors progress and develops reports required by the annual Quality Management Work plan.
• Implements utilization review and quality assurance reviews; coordinates Quality Improvement Committee.
• Serves on local and state committees or task forces.
• Monitors agreements and contracts with providers as assigned.
• Initiates, develop and revise written policies and procedures for quality management and compliance programs.
• Participates in audits, reviews, and investigations of program operations and client services to ensure compliance with regulatory requirements.
• Works closely with managers in developing program policies which meet federal, state, and local government requirements.
• Maintains up-to-date knowledge of relevant laws, regulations, and best practices in quality management and behavioral health.
• Attends relevant state and regional meetings.

Quality Management Specialist II

• The Quality Management Specialist II performs the above duties but may be assigned more complex and difficult duties with limited supervision and direction.
• Reviews and approves Treatment Authorization Requests (TARs) to assess eligibility criteria and ensure payment approval.
• Authorizes 24-hour notifications for inpatient hospital placements.
• Conducts concurrent reviews of placements to ensure compliance with established guidelines and best practices.
• Reviews and signs off on documentation related to the progress and assessment notes of registered interns and student interns.
• Provides oversight and ensuring compliance with the Peer Specialist documentation and program requirements.
• Monitors charts for adherence to compliance standards, with an emphasis on preventing Fraud, Waste, and Abuse.
• Reviews and approves diagnoses on 5150 evaluations and providing ongoing oversight of 5150 and crisis management protocols, when assigned to the Behavioral Health Division.
• Conducts training sessions for clinical staff on new Behavioral Health Integration Notices (BHINs) and offering continuous support and guidance to all clinical personnel, when assigned to the Behavioral Health Division.

Knowledge of:

• Behavioral health systems and related legislation.
• Program planning, evaluation, needs assessment and quality review principles.
• Federal, state, and local guidelines for utilization review and compliance.
• Social Drivers of Health (e.g., housing, education, income, transportation, food security, and their influence on behavioral health outcomes and service delivery, as well as strategies for addressing these determinants.

Ability to:

• Plan, organize, and coordinate program development and performance monitoring.
• Develop and interpret policies, procedures, and regulations.
• Community effectively and prepare clear, logical reports.
• Build and maintain relationships with stakeholders.

EDUCATION AND EXPERIENCE:

Quality Management Specialist I

Option 1

A bachelor’s degree from an accredited college or university in public health, social work, behavioral health, or other health related field, AND a minimum of one (1) year of experience in quality management, compliance, or a behavioral health setting.

Option 2

An associate’s degree or equivalent from an accredited institution AND three (3) years of experience in quality management, compliance, behavioral health, public health, social work or other health related fields.

Option 3

A high school diploma or GED and five (5) years of experience in behavioral health, social services, public health, or health related fields, with demonstrated expertise in process improvement or regulatory compliance.

Quality Management Specialist II

In addition to the above, Licensure in California as a Licensed Clinical Social Worker (LCSW), Marriage and Family therapist (MFT), or related California license is required.

PHYSICAL DEMANDS AND WORKING CONDITIONS

The conditions herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

PHYSICAL DEMANDS: Mobility to work in a standard office environment, use standard office equipment and attend off-site meetings; physical ability to sit or otherwise remain stationary at work post for long periods of time; manual dexterity to use standard office equipment and supplies and to manipulate both single sheets of paper and large document holders (binders, manuals, etc.); vision to read handwritten and printed materials and a computer screen; hearing and speech to communicate person and by telephone.

WORKING CONDITIONS: Essential functions are regularly performed without exposure to adverse environmental conditions; work is performed in a standard, temperature-controlled environment subject to typical office noise and environment.

OTHER REQUIREMENTS:

This class description lists the major duties and requirements of the job and is not all-inclusive. Not all duties are necessarily performed by each incumbent. Incumbents may be expected to perform job-related duties other than those contained in this document and may be required to have specific job-related knowledge and skills.