QA QI Analyst – DMC – ODS
Job Description:
- Support the implementation of DMC-ODS requirements across access, network, utilization management, reporting, member information, and quality improvement functions
- Maintain utilization management tracking tools, logs, and documentation files
- Coordinate credentialing/recredentialing packets and provider directory updates
- Collect, organize, and analyze quality, utilization, access, grievance, provider performance, and compliance data to identify trends, risks, and follow-up needs
- Coordinate meetings, agendas, materials, notes, follow-up items, and documentation for quality management, provider monitoring
Requirements:
- 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
- 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
- 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
Benefits:
- Access to various applications
- Maintain confidentiality and integrity of systems
