Evaluation Program Manager

CHC•San Jose, CA

19h

About The Position

The Evaluation Program Manager provides clinical leadership, program oversight, and regulatory compliance management for evaluation services within the Medi‑Cal clinic. This role ensures that all evaluation services comply with California Medi‑Cal (DHCS) requirements, including medical necessity standards, documentation accuracy, billing compliance, scope of practice, and supervision requirements. Working within an interdisciplinary environment, the Evaluation Program Manager supports timely access to medically necessary evaluation services that promote positive outcomes for children and families. In partnership with the Medi‑Cal Clinic Director, this position ensures that evaluation services are delivered in accordance with federal and state regulations, clinic policies, licensing standards, and audit readiness expectations. The Evaluation Program Manager provides clinical supervision, consultation, and training to clinicians and trainees delivering evaluation services and actively participates in program development, utilization management, and quality improvement activities. The position maintains a billable clinical caseload consistent with Medi‑Cal documentation, coding, and productivity requirements.

Requirements

Educational specialist from an accredited graduate school, with experience in either/both a pediatric clinic and/or school-based setting.; or Master’s degree (MA/MS) in a related clinical field with relevant experience.
Demonstrated adherence to all professional, ethical, legal and confidentiality issues outlined by APA and Federal laws (e.g., HIPAA).
Knowledge and understanding of CHC’s four areas of expertise: ADHD, LD, Anxiety & Depression and Autism Spectrum Disorders.
Strong clinical skills in child, adolescent, and family assessment, case formulation, and treatment planning.
Experience managing or coordinating clinical services and workflows.
Demonstrated ability to provide training, supervision, or consultation to clinicians and trainees.
Demonstrated knowledge of California Medi‑Cal documentation, medical necessity, billing, and audit requirements.
Strong understanding of supervision requirements, scope of practice, and credentialing standards for Medi‑Cal‑reimbursable services.
Ability to identify, mitigate, and remediate compliance risks related to Medi‑Cal services.
Excellent organizational, time-management, and prioritization skills.
Ability to work effectively in a collaborative, team-oriented environment.
Strong interpersonal and written communication skills with clients, families, and colleagues.
Flexibility and responsiveness to changing clinical, regulatory, and programmatic priorities.
Proficiency with computers, telehealth platforms, and electronic health records (EHR).
An employee in this position may be required to occasionally lift, move, and set up stacks of documents such as training binders or other training materials, laptop computers, in-focus projectors, flip charts, and other materials required for training sessions.
Adherence to all professional, ethical, legal and confidentiality issues outlined by the California Board of Psychology, The American Psychological Association, and State and Federal laws.
The Evaluation Program Manager is responsible for supporting Medi‑Cal compliance and audit readiness by ensuring that evaluation services are delivered, documented, and billed in accordance with DHCS regulations, Medi‑Cal provider manuals, clinic policies, and applicable state and federal laws. This includes participation in audits, chart reviews, corrective action planning, and ongoing quality improvement activities.
Excellent interpersonal and written communication skills with both client and colleagues.

Responsibilities

Provide ongoing clinical and operational oversight of Medi‑Cal evaluation services to ensure compliance with DHCS regulations, Medi‑Cal provider manuals, and clinic policies.
Review and track internal referrals for evaluations, ensuring timely access and appropriate authorization for Medi‑Cal beneficiaries.
Determine and document medical necessity for evaluation services in accordance with Medi‑Cal standards, in consultation with a licensed psychologist or neuropsychologist as required by scope‑of‑practice and supervision regulations.
Assign evaluation cases to qualified team members (e.g., licensed psychologists, doctoral interns, postdoctoral fellows, and allied health professionals) based on credentialing, supervision requirements, and Medi‑Cal compliance standards.
Ensure that all evaluation services, documentation, and reports meet Medi‑Cal requirements for completeness, accuracy, timeliness, and audit readiness.
Collaborate with Clinical Services leadership to develop, implement, maintain, and regularly update policies, procedures, and clinical protocols related to evaluation services, incorporating changes in Medi‑Cal regulations and guidance.
Serve as the primary point of contact for evaluation‑related compliance concerns, clinical workflows, and audit inquiries related to Medi‑Cal services.
Provide clinical training, consultation, and guidance on Medi‑Cal documentation, coding, billing workflows, supervision requirements, and evaluation best practices for staff and trainees.
Maintain and update evaluation‑related content in CHC clinical manuals and training materials to reflect current Medi‑Cal regulations and internal compliance standards.
Partner with the Medi‑Cal Clinic Director and Training Director to support recruitment, onboarding, credentialing, and retention of evaluation clinicians in alignment with Medi‑Cal participation requirements.
Deliver billable direct clinical services, including evaluations and related services, in compliance with Medi‑Cal billing, documentation, and productivity expectations.
Participate in utilization management, quality improvement initiatives, chart reviews, and corrective action processes as assigned to ensure ongoing compliance and service integrity.