The business problem is to improve member outcomes, address social drivers of health, and ensure compliance with Medi-Cal and regulatory reporting requirements for high-need, high-risk populations enrolled in Enhanced Care Management (ECM) programs.
Requirements
- Proficiency in SQL, Excel, and data visualization tools (Tableau, Power BI, or equivalent).
- Working knowledge of statistical analysis tools (Python, R, or SAS).
- Experience with EHR systems, care management platforms, and claims/utilization data.
- Understanding of risk stratification, predictive modeling, and population health analytics.
- Familiarity with healthcare quality measures (HEDIS, UDS, CMS Core Measures) and Medi-Cal reporting requirements.
- Experience working with Medi-Cal programs, Enhanced Care Management, Whole Person Care, or related initiatives strongly preferred.
- Bachelor’s degree in Data Analytics, Public Health, Healthcare Administration, Statistics, or related field (master’s preferred).
Responsibilities
- Extract, validate, and analyze data related to ECM members, including demographics, risk stratification, utilization, quality measures, and social determinants of health (SDOH).
- Develop and maintain dashboards, scorecards, and reports to track program enrollment, outreach, engagement, and outcomes.
- Monitor performance against ECM contractual requirements and state-mandated reporting metrics.
- Identify trends in emergency department use, hospital admissions, chronic condition management, and member engagement to drive targeted interventions.
- Support quality improvement projects by analyzing root causes, evaluating effectiveness of interventions, and recommending data-driven strategies.
- Ensure accuracy, integrity, and security of sensitive member data in compliance with HIPAA and Medi-Cal standards.
- Assist in preparing required reports for health plans, state agencies, and accrediting bodies.
Other
- Collaborate with ECM care managers, social workers, and clinicians to provide data that supports individualized care planning and population health strategies.
- Participate in cross-departmental initiatives to improve care delivery and reduce health disparities.
- Commitment to health equity, cultural competency, and addressing social drivers of health.
- Strong analytical and critical thinking skills with attention to detail.
- Ability to clearly communicate insights to both clinical and non-technical staff.
