Location: Hybrid – Occasional in-office collaboration in San Diego
Employment Type: Full-Time
Hourly Pay Range: $24 – $27 per hour
About Pacific Health Group
At Pacific Health Group, we are at the forefront of revolutionizing healthcare. You will play a vital role in this mission. We are dedicated to improving health outcomes by addressing social determinants of health and coordinating comprehensive community-based services, particularly through our programs. If you are passionate about making a difference and have the skills to lead in this dynamic environment, we invite you to join our team.
Overview
The Data Administrator is a key individual-contributor role responsible for maintaining the integrity, accuracy, and compliance of organizational data. This position ensures timely reporting, seamless system integration, and strategic insights that support both day-to-day operations and long-term organizational growth. The role requires high attention to detail, strong organizational skills, and the ability to collaborate across teams to ensure reliable data-driven decision-making.
Key Responsibilities
Health Plan Compliance Submissions
- Oversee the monthly and quarterly submission of Enhanced Care Management (ECM) Report Template Files (RTF) and Outreach Transmission Files (OTF) to all contracted health plans.
- Gather, validate, and consolidate data from multiple internal systems, ensuring accuracy of member demographics, service dates, and case notes.
- Ensure all submissions meet health plan-specific formatting and regulatory requirements to maintain compliance.
- Monitor submission timelines, confirm receipt with health plans, and troubleshoot errors or rejections quickly to avoid penalties.
Member Eligibility and Authorization
- Conduct recurring eligibility checks to confirm members remain qualified for ECM, Medi-Cal, and other service programs.
- Partner with case managers to reassess member needs and adjust service enrollments accordingly.
- Document all re-qualification activities in compliance with audit standards and payer expectations.
- Update member statuses promptly to ensure accurate resource allocation and continuity of care.
- Manage the end-to-end process for obtaining initial authorizations and subsequest reauthorizations through various provider portals.
- Track the status of all authorizations, maintaining detailed records of approvals, denials, and pending renewals.
System Data Integrity
- Maintain a consolidated and reliable view of all member touchpoints by duplicating Lead Care Manager (LCM) notes from TheraPlatform into SalesMate.
- Standardize note formatting and apply appropriate tags or categories for efficient retrieval and reporting.
- Perform regular audits to identify missing or incomplete data entries and resolve discrepancies with care teams.
- Ensure that data captured across platforms supports continuity of care and enhances leadership visibility.
Leadership Reporting
- Compile weekly updates on member statuses, including active, pending, and closed cases, and distribute to executive and leadership teams.
- Track and highlight trends such as outreach completion rates, reassessment activity, and engagement levels.
- Translate raw data into actionable insights that enable leadership to make timely, data-driven decisions.
- Deliver clear reports to multiple stakeholders, including department heads, sales teams, and executive leadership.
Member Profile Oversight
- Review and update member profiles regularly to ensure active/inactive statuses are correct and align with real-time service delivery.
- Confirm discharge reasons, service end dates, and member transitions are fully documented for compliance.
- Flag discrepancies proactively and work directly with care teams to resolve errors.
- Maintain health plan compliance standards by ensuring member record integrity and audit readiness.
Operational Reporting
- Produce recurring weekly and monthly reports to monitor organizational performance and compliance.
- Track key indicators such as member counts, service utilization, eligibility changes, and program engagement rates.
- Provide tailored progress reports to leadership or external partners to demonstrate accountability.
- Support internal audits and quality improvement initiatives by providing clear, accurate, and timely data.
Research & Expansion Insights
- Aggregate demographic, economic, and healthcare utilization data to identify new regions for community-based program expansion.
- Conduct in-depth research on local regulations, health plan coverage, and community needs to ensure successful placement.
- Build and maintain structured databases of potential partners, community events, and opportunities for organizational outreach.
- Validate data sources for accuracy and reliability to support leadership in making informed, evidence-based decisions.
Event Planning & Outreach Support
- Research and curate a calendar of community events, conferences, and networking opportunities aligned with organizational goals.
- Assess the strategic value of events based on target populations, potential partnerships, and visibility opportunities.
- Partner with internal teams to coordinate event participation, including logistics, staffing, and materials.
- Track outcomes and engagement metrics post-event to evaluate return on investment and guide future planning.
Other Duties as Assigned
- Support evolving priorities by assisting with data system implementations, migrations, and workflow redesigns.
- Participate in special projects such as large-scale data audits or 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.
Requirements
- Bachelor’s degree in data management, healthcare administration, information systems, or related field (or equivalent experience).
- Experience in healthcare data administration, reporting, or compliance strongly preferred.
- Proficiency with CRM platforms, reporting dashboards, and data entry tools (TheraPlatform, SalesMate a plus).
- Strong analytical, organizational, and problem-solving skills.
- Ability to communicate clearly with executives, managers, and cross-functional teams.
- Preferred: Familiarity with Medi-Cal, ECM, CalAIM, and health plan compliance processes.
Benefits
Time Off & Leave
- 160 Hours of Paid Time Off (PTO)
- 12 Paid Holidays per year, including your birthday and one floating holiday after 1 year of employment
- 4 Paid Volunteer Hours per Month to support causes you care about
- Bereavement Leave, including Fur Baby Bereavement
Health & Wellness
- 90% Employer-paid Employee-Only Medical Benefits
- Flexible Spending Account (FSA)
- Short-Term & Long-Term Disability | AD&D
- Employee Assistance Program (EAP)
Financial & Professional
- 401(k) with Company Match
- Monthly Stipend
- Opportunities for professional development and internal growth
Culture & Perks
- Employee Discounts via Great Work Perks and Perks at Work
- Quarterly In-Person Events
Equal Opportunity Employer
Pacific Health Group is an Equal Opportunity Employer. We are committed to creating an inclusive and equitable workplace where all individuals are treated with dignity and respect. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex (including pregnancy, childbirth, breastfeeding, and related medical conditions), gender, gender identity or gender expression, sexual orientation, national origin or ancestry, citizenship status, physical or mental disability, medical condition (including cancer and genetic characteristics), age (40 and over), marital status, military or veteran status, genetic information, or status as a victim of domestic violence, assault, or stalking. We value diversity in all forms and encourage individuals from historically underrepresented communities to apply.
Job Application & Offer Disclaimer
Pacific Health Group is committed to maintaining a transparent, lawful, and secure hiring process in compliance with California labor laws and employment standards. No candidate will be offered employment without meeting the required qualifications and skillset for the position and successfully completing all steps of our recruitment process, which include:
• Submission of a completed internal application via our HRIS system
• A formal pre-screen with our recruiting team
• Completion of a skills assessment (if applicable to the position)
• Participation in a final interview with hiring leadership
• Receipt of a formal verbal offer from our authorized hiring team
AI & Human Interaction (HI) in Recruitment
Pacific Health Group is committed to fairness, equity, and transparency in our hiring practices. We use AI (Artificial Intelligence) tools to help match candidate resumes against our job descriptions, focusing on qualifications, skillsets, and location.
All resumes that meet these criteria are then reviewed by HI (Human Interaction) — our recruiting and HR team. Pacific Health Group remains true to our Equal Employment Opportunity (EEO) statement, ensuring that every candidate is given fair and consistent consideration.
