CA Advancing and Innovating Medi-Cal -known as Cal. AIM - is a far-reaching, multiyear plan to transform California's Medi-Cal program and to make it integrate more seamlessly with other social services. Led by California's Department of Health Care Services, the goal of Cal. AIM is to improve outcomes for the millions of CA's covered by Medi-Cal, especially those with the most complex needs. Come join our Enhanced Care Management and Community Supports team, partnering with managed care health ... more details
Who We Are
Pacific Clinics is California's largest community-based nonprofit provider of behavioral and mental health services and support. Our team of more than 2,000 employees speak 22 languages and are dedicated to offering hope and unlocking the full potential of individuals and families through culturally responsive, trauma-informed, research-based services for individuals and families from birth to older adults.
Who We Serve
Pacific Clinics serves children, transitional age youth, families, adults, and older adults. We offer a full range of mental and behavioral health services, foster care and social services, housing, continuing adult education and early childhood education programs to Medi-Cal eligible individuals and families throughout Alameda, Contra Costa, Fresno, Kings, Los Angeles, Madera, Orange, Placer, Riverside, Sacramento, San Bernardino, San Francisco, Santa Clara, Solano, Stanislaus, Stockton, Tulare and Ventura Counties.
What We Offer
- The compensation for this position can be up to $134,726.19 Annually. Compensation will vary based on qualifications, skills, experience, and geographic location. The salary range may also vary if you reside in a different location than the location posted.
- We Offer Medical, Dental & Vision benefits, retirement options, Flex Spending, EAP, and more!
- Employee engagement and advocacy opportunities to advance our justice, equity, diversity, and inclusion agenda across our Agency and throughout the communities we serve.
JOB SUMMARY
Program Description: CA Advancing and Innovating Medi-Cal -known as CalAIM – is a far-reaching, multiyear plan to transform California's Medi-Cal program and to make it integrate more seamlessly with other social services. Led by California's Department of Health Care Services, the goal of CalAIM is to improve outcomes for the millions of CA's covered by Medi-Cal, especially those with the most complex needs. Come join our Enhanced Care Management and Community Supports team, partnering with managed care health plans, and change the landscape of Behavioral Health and integrated care in our state!
Works within the agency and program’s vision, mission and philosophy, and policies of the agency in partnership with the leadership team. The Data Analyst- Managed Care is responsible for supervising the entry, tracking, management, analysis, and oversight of all data and reports for the CalAIM programs (Enhanced Care Management and Community Supports). This position works with the Associate Director of Member Engagement and Outreach and CalAIM leadership to ensure ongoing analysis and accuracy of data for CalAIM's various data entry systems and to produce reports as required.
RESPONSIBILITIES AND DUTIES
1. Oversees and facilitates new health plan portal trainings and provides technical assistance for CalAIM program staff.
2. Manages performance measurements and outcomes within Salesforce, agency EHR, health plan portals and required data systems to ensure contractual compliance.
3. Attends all applicable health plan meetings, forums and webinars related to reporting changes and updates and provides feedback to appropriate agencies as needed.
4. Acts as the CalAIM programs liaison to internal IT, external system partners, and health plan data partners to ensure compliance and accuracy with data, reporting, and system build outs and supports roll outs of new data and reporting specs.
5. Analyzes data and generates reports from internal EHRs and health plan portals for the purpose of, but not limited to: Data Integrity, Annual Progress, incoming and outgoing data files, data analysis, etc. Create Ad Hoc Reports as needed.
6. Manages and conducts analysis of MIF, RTF, OTF, and roster data to complete Annual Progress Reports as required for internal program as well as health plan contracts.
7. Manages and conducts analysis of funding data to prepare and ensure timely completion and submission of claims and services to meet contractual requirements, working directly with program, health plans, and third-party biller.
8. Manages and conducts analysis of all CalAIM programs master data to prepare and ensure timely completion and submission of all required reports related to but not limited to MIF, RTF, OTF, etc.
9. Monitors and provides regular updates to CalAIM Management regarding Data Integrity and data errors and ensures the timely resolution of all data issues.
10. Monitors agency adherence to health plan portals operating policies and procedures, and in accordance with Pacific Clinics HIPAA policies.
11. Completes health plan portals Agency Administrator functions such as creating new user accounts, adding NPIs and/or customer records to health plan portals, etc. as well as supports with QHIO functions.
12. Completes data entry functions into the health plan portals such as client intakes, VI-SPDAT’s, annual assessments, enrollment status updates, and snapshot updates as required.
13. Monitors CalAIM programs chart compliance with health plan contracts on an ongoing basis.
14. Ensures congruence of chart information with health plan data.
15. Supports with creating/updating program processes to ensure data accuracy and compliance
16. Other Duties as necessary for business operations
JOB SPECIFIC COMPETENCIES
1. Strong data analysis skills and strong skills using Excel, Pivot Table, Power Pivot and similar programs.
2. Strong computer skills using Microsoft Office suite as well as Internet proficiency required
3. Excellent oral and written communication skills. Must be able to communicate effectively both verbally and in writing.
4. Strong in paperwork, documentation and tracking.
5. Establish and maintain effective working relationships with coworkers, clients, and community agencies.
6. Prepare and complete reports accurately.
7. Assemble, organize and present factual data derived from a variety of sources.
8. Must possess a valid California Driver’s license and maintain an insurable driving record under the Clinics' liability policy.
9. Familiarity or experience in health administration, mental health, housing data preferred.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
MINIMUM EDUCATION AND/OR EXPERIENCE
• Bachelor’s degree in related field and/or 5 years of analytical experience in the areas of health administration, housing, homeless data, mental health, data management, etc.
• Minimum of five (5) years of experience using data systems
PREFERRED QUALIFICATIONS
• Familiarity with health administration, mental health, and housing data and systems preferred.
PHYSICAL REQUIREMENTS
The work environment conditions as described below 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 qualified individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee may be required to stand, walk, run, sit, use hands to handle or feel objects, tools or controls; reach with hands and arms; and taste or smell. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
LEVEL OF CONTACT WITH CHILDREN:
May/will have supervised contact with children.
May/will have unsupervised contact with children.
Will not have unsupervised contact with children
Requires full background check and TB exam
Current First Aid/CPR Certification.
DRIVING PRIVILEGES
May be called upon to drive on agency business. Needs acceptable MVR and appropriate insurance coverage.
Required to drive agency vehicle. Must have clean MVR, appropriate insurance coverage, and attend agency driver training.
TRAINING
Needs to successfully complete all required agency training indicated for this position.
