Licensed Clinical Review Specialist - In-Custody Case Management

HealthRIGHT 360•Fairfield, CA

9d•Onsite

About The Position

CalAIM is a Department of Health Care Services (DHCS) initiative designed to enhance the quality of life and health outcomes for Medi-Cal recipients through system reforms. The Case Management In-Custody program, part of California’s Justice-Involved Reentry initiative, requires correctional facilities to offer targeted Medi-Cal services up to 90 days before an individual's release. Eligible incarcerated adults are automatically enrolled in Enhanced Care Management (ECM), which assigns a lead care manager to coordinate physical, behavioral, and social services during the transition period. The Licensed Clinical Review Specialist (LCRP) is responsible for clinically reviewing documentation, case notes, assessments, and care plans for HealthRIGHT 360's jail-based case management program. This review ensures that all services comply with Medi-Cal billing standards, state compliance guidelines, and organizational quality requirements. The role involves reviewing and supporting Health Risk Assessments, monitoring case management practices for clinical and regulatory compliance, and providing feedback and consultation to case management staff to foster high-quality service delivery. Additionally, the Licensed Clinical Review Specialist may offer direct clinical case management services to clients with complex or escalated needs. This position acts as a crucial link between correctional care, clinical quality assurance, care coordination, and public funding compliance, thereby supporting effective service delivery, positive client outcomes, and adherence to local, state, and federal requirements.

Requirements

Master’s degree in counseling, social work, or related field.
Current Behavioral Board of Sciences (BBS) license from an accredited institution recognized in California (LMFT, LPCC, LCSW).
License must be current and in good standing.
Current First Aid and CPR certification.
Valid California driver’s license and access to registered and insured transportation.
Minimum of 3 years clinical experience, with at least 1 year in care management, population health, or related field.
Previous Clinical experience working with individuals recently released from jail or prison or experiencing homelessness.
Experience working with clients experiencing acute withdrawal from substances.

Nice To Haves

Experience working with Medi-Cal, Medi-Care, and private medical insurance plans preferred.
Experience providing trauma-informed services preferred.

Responsibilities

Audit clinical case management notes for accuracy and necessity.
Review case notes and supporting documentation to ensure compliance with program, regulatory, and billing requirements.
Verify that all documentation fulfills California Medi-Cal criteria.
Review each Comprehensive Assessment, Health Risk Assessment (HRA), additional assessments, and Care Plans developed by Case Management In-Custody staff.
Enter documentation of services provided in applicable EHR and/or Provider portal within 24 hours of service delivery.
Ensure care plans match the client's documented clinical needs.
Provide feedback to Case Managers to improve documentation quality.
Monitor case management activities and documentation to ensure adherence to Medi-Cal requirements and organizational standards.
Collaborate with the care management team to establish quality improvement initiatives.
Provide oversight and assistance to the Case Management In-Custody team to support effective service delivery while ensuring compliance with local, state, and federal regulations and guidelines.
Assist with Case Management In-Custody member cases that require additional or escalated clinical assistance.
Provide clinical case management services for clients as needed, particularly in complex or high-acuity situations.
Provide consultation and support to staff as needed, including being available for Lead Case Managers (LCMs) to debrief difficult situations.
Provide consultation regarding clinical and administrative issues to other resources as requested.
Serve as a clinical liaison between the Case Management In-Custody program, healthcare providers, and community resources to foster collaboration and coordinate care.
Participate in Solano County and HealthRIGHT 360 meetings on a recurring basis (e.g., care plan development, care plan updates due to changes in member condition, and Interdisciplinary Care Team (ICT) meetings).
Participate in multidisciplinary teams and committees to advocate for Case Management In-Custody services and the members served.
Participate in required internal and external meetings related to care planning, care coordination, quality assurance, and program operations.
Complete other duties, special projects, and assignments as directed by the supervisor.
Attend workshops, meetings, and training as requested by supervisor.