Senior Data Validation Program Manager

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive.  This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on 5 Core Values in the workplace:

•    Integrity

•    Accountability

•    Collaboration

•    Trust 

•    Respect

Disclaimers:

•    Flexible work schedule is based on job duties, department, organization, or business need.

•    Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

The Senior Data Validation Program Manager reports to the Director of Dual Special Needs Plan and is responsible for implementation and monitoring of the Medicare Data Validation requirements for Part C & D and SNP, as well as Medi-Cal Data Validation. This position will support and ensure that impacted businesses departments are tracking and adhering to the technical and reporting requirements.  This includes but not limited to the following:  Model of Care, Network, Utilization Management, Pharmacy Part D, and Grievance and Appeals, and Risk Adjustment for both C and D Data Validation. 

The successful candidate is a subject matter expert (SME) in regulations that govern the CMS Medicare D-SNP and Medi-Cal reporting requirements and in the application of operational strategies and tactics to maximize the annual Data Validation audit scores. The Senior Data Validation Program Manager will serve as a high-level individual contributor. 

Amount of Travel Required: 10-20%

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

ESSENTIAL FUNCTIONS

Job Function & Responsibilities

Reporting and Documentation:

•    Leads in generating detailed reports on data validation findings, documenting validation procedures, and maintaining comprehensive documentation for audit purposes.

Issue Resolution:

•    Leads issue resolution organizationally by investigating data quality issues, collaborating with relevant stakeholders to resolve discrepancies, and implementing corrective actions to prevent future errors. 

Data Quality Analysis:

•    Leads data quality analysis in conducting thorough data quality reviews, identifying data inconsistencies, anomalies, and potential errors across various data sources.

Developing Validation Strategy:

•    Designs and implements comprehensive data validation plans, defining data quality metrics, and establishing standards for data acceptance criteria. 

Compliance Assurance:

•    Ensures adherence to data quality standards, regulatory requirements, and industry best practices.

Process Improvement:

•    Identifies opportunities to optimize data validation processes, implementing new tools or technologies to enhance efficiency and effectiveness. 

•    Participates in the development of new processes and best practices and assist with providing training and awareness to other business groups affected by new activities. 

Stakeholder Management:

•    Communicates validation results to key stakeholders, including business owners, data analysts, and project managers, and addressing any concerns raised. 

MINIMUM QUALIFICATIONS

Education & Experience: 

Required Education and Experience:

•    Bachelor’s degree in health or business related such as Public Health, Health Administration, or Social Work

•    5 years of analytics experience required 

•    Working knowledge of NCQA standards, SNP require