RESEARCH DATA SPECIALIST II

State of California•Sacramento, CA

41d•Hybrid

About The Position

The Capitated Rates Development Division is responsible for the development of managed care capitation rates for more than 10 million Medi-Cal beneficiaries in all of California's 58 counties. Under the general direction of the Section Chief, the Research Data Specialist II (RDS II) designs and directs major, complex research projects or activities. The incumbent independently plans, organizes, and conducts complicated studies, requiring in-depth knowledge, pertaining to the Medi-Cal managed care financial delivery system, such as intergovernmental transfer programs, directed payments, Medi-Cal managed care plan (MCP) financial reporting, medical loss ratio reporting, managed care waiver programs and reporting, budgetary analysis and policy changes for the Local Assistance Estimate, and the enforcement of Centers for Medicare and Medicaid Services (CMS) special terms and conditions. The RDS II provides expert consultative services on the feasibility, impact, or potential of proposed initiatives, policy changes, or program changes. The purpose of the studies is to advise the Division's management of the performance of Medi-Cal managed care health plans and to positively influence future policies and strategies to meet statewide health policy goals. Other duties include performing complex analysis to support and assist actuaries setting managed care rates, as well as developing program calculations. Managing encounter, eligibility, demographic, and other data required for the Medi-Cal Managed Care program. The incumbent also assists with duties including but not limited to: capitation payment support, financial audits, risk corridors, and incentive programs.

Responsibilities

Designs and directs major, complex research projects or activities.
Independently plans, organizes, and conducts complicated studies, requiring in-depth knowledge, pertaining to the Medi-Cal managed care financial delivery system
Provides expert consultative services on the feasibility, impact, or potential of proposed initiatives, policy changes, or program changes.
Advises the Division's management of the performance of Medi-Cal managed care health plans and to positively influence future policies and strategies to meet statewide health policy goals.
Performs complex analysis to support and assist actuaries setting managed care rates, as well as developing program calculations.
Managing encounter, eligibility, demographic, and other data required for the Medi-Cal Managed Care program.
Assists with duties including but not limited to: capitation payment support, financial audits, risk corridors, and incentive programs.