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Pacific Health Group

Integrated Medi-Cal care coordination provider

Data Administrator

Data EntryConfirmed live in the last 24 hours
Full-timeSan Diego, CA, USA

About the Job

Requirements

  • A bachelor's degree in data management, healthcare administration, information systems, or a related field, or equivalent experience.
  • Experience in healthcare data administration, reporting, or compliance is strongly preferred.
  • Proficiency with customer relationship management (CRM) platforms, reporting dashboards, and data entry tools; experience with TheraPlatform and SalesMate is a plus.
  • Ability to communicate clearly with executives, managers, and cross-functional teams.

Responsibilities

  • Oversee monthly and quarterly submissions of Enhanced Care Management Report Template Files and Outreach Transmission Files to contracted health plans.
  • Gather, validate, and consolidate data from multiple internal systems, ensuring accuracy of member demographics, service dates, and case notes.
  • Ensure submissions meet health plan-specific formatting and regulatory requirements.
  • Monitor submission timelines, confirm receipt with health plans, and troubleshoot errors or rejections.
  • Conduct recurring eligibility checks to confirm members remain qualified for Enhanced Care Management, Medi-Cal, and other service programs.
  • Partner with case managers to reassess member needs and adjust service enrollments.
  • Document re-qualification activities in compliance with audit standards and payer expectations.
  • Update member statuses promptly to support accurate resource allocation and continuity of care.
  • Manage the end-to-end process for obtaining initial authorizations and subsequent reauthorizations through provider portals.
  • Track authorization status and maintain records of approvals, denials, and pending renewals.
  • Maintain a consolidated view of member touchpoints by duplicating Lead Care Manager notes from TheraPlatform into SalesMate.
  • Standardize note formatting and apply appropriate tags or categories for retrieval and reporting.
  • Audit data entries regularly to identify missing or incomplete information and resolve discrepancies with care teams.
  • Ensure data across platforms supports continuity of care and leadership visibility.
  • Compile weekly updates on active, pending, and closed member cases and distribute them to executive and leadership teams.
  • Track trends such as outreach completion rates, reassessment activity, and engagement levels.
  • Translate raw data into actionable insights for leadership decision-making.
  • Deliver reports to department heads, sales teams, executive leadership, and other stakeholders.
  • Review and update member profiles to ensure active or inactive statuses align with real-time service delivery.
  • Confirm discharge reasons, service end dates, and member transitions are documented for compliance.
  • Flag discrepancies and work with care teams to resolve errors.
  • Maintain member record integrity and audit readiness in accordance with health plan compliance standards.
  • Produce recurring weekly and monthly reports to monitor organizational performance and compliance.
  • Track member counts, service utilization, eligibility changes, and program engagement rates.
  • Provide tailored progress reports to leadership or external partners.
  • Support internal audits and quality improvement initiatives with accurate, timely data.
  • Aggregate demographic, economic, and healthcare utilization data to identify regions for community-based program expansion.
  • Research local regulations, health plan coverage, and community needs to support program placement.
  • Build and maintain structured databases of potential partners, community events, and outreach opportunities.
  • Validate data sources to support evidence-based decisions.
  • Research and curate a calendar of community events, conferences, and networking opportunities aligned with organizational goals.
  • Assess event value based on target populations, potential partnerships, and visibility opportunities.
  • Coordinate event participation, including logistics, staffing, and materials, with internal teams.
  • Track post-event outcomes and engagement metrics to evaluate return on investment and guide future planning.
  • Assist with data system implementations, migrations, and workflow redesigns as priorities evolve.
  • Participate in special projects such as large-scale data audits and compliance-focused reviews.
  • Help onboard and train new staff in data procedures, system use, and reporting protocols.
  • Work cross-functionally with IT to troubleshoot system issues and optimize workflows.

Desired Qualifications

  • Familiarity with Medi-Cal, Enhanced Care Management, California Advancing and Innovating Medi-Cal, and health plan compliance processes.

About the Company

Pacific Health Group

Integrated Medi-Cal care coordination provider

Pacific Health Group provides integrated Medi-Cal care coordination in California, working with 39 health plans to serve more than 38,000 members across 44 counties. Its flagship Enhanced Care Management coordinates medical, behavioral, and social services for members with complex needs, complemented by Community Supports like housing navigation, rent assistance, medically tailored meals, and home modifications. Street Medicine reaches unsheltered individuals, while Community Health Workers provide culturally responsive care navigation and advocacy; additional services include behavioral health support, medical transportation, and a Clubhouse program for adults with mental illness. The approach follows CalAIM’s whole-person care, addressing social determinants of health to reduce fragmentation and improve stability for at-risk Medi-Cal beneficiaries.

Company size
51-200
Company stage
Not listed
Total funding
Not listed
Headquarters
Carlsbad, CA
Founded
2023

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