Licensed Clinical Review Specialist - In-Custody Case Management

CalAIM, a Department of Health Care Services (DHCS) initiative, aims to improve Medi-Cal recipients' quality of life and health outcomes through system reforms. The Case Management In-Custody program through California’s Justice-Involved Reentry initiative mandates correctional facilities to provide targeted Medi-Cal services up to 90-days before release. Eligible incarcerated adults are auto enrolled in Enhanced Care Management (ECM), which provides a lead care manager to coordinate physical, behavioral, and social services seamlessly during transition.

The Licensed Clinical Review Specialist (LCRP) conducts clinical reviews of documentation, case notes, assessments, and care plans for HealthRIGHT 360's jail-based case management program, ensuring all services meet Medi-Cal billing standards, state compliance guidelines, and organizational quality requirements. This role is responsible for 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 promote high-quality service delivery. The Licensed Clinical Review Specialist may also provide direct clinical case management services for clients with complex or escalated needs. Serving as a bridge between correctional care, clinical quality assurance, care coordination, and public funding compliance, this position supports effective service delivery, positive client outcomes, and adherence to local, state, and federal requirements.

KEY RESPONSIBILITIES

Documentation & Clinical Record Review

• 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.

Quality Assurance & Compliance

• 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.

Clinical Consultation & Case Support

• 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.

Care Coordination & Community Collaboration

• 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.

Administrative & Program Support

• 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.

QUALIFICATIONS

Education, Certification, or Licensure

• 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.

Experience

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