California Department of Managed Health Care
Initial Review Lead Analyst
California Department of Managed Health Care, California, Missouri, United States, 65018
Initial Review Lead Analyst
California Department of Managed Health Care
Job Summary The Initial Review Lead Analyst functions within the Initial Review Unit (IRU) under the direction of the IRU Supervisor I. The analyst will act in a lead capacity as a subject matter expert, performing case audits, screening, analysis, and triaging of Independent Medical Review (IMR) applications and incoming complaints against licensed health plans. The role also includes implementing, monitoring, and evaluating health program activities, assessing and developing training materials within the Initial Review Section (IRS).
Job Details
Job Code: JC-503931
Position Number(s): 409‑301‑5393‑139
Work Location: Sacramento County
Telework: Hybrid
Job Type: Permanent, Full Time
Number of Positions: 1
Responsibilities
Perform case audits, screening, and analysis of IMR applications.
Triage incoming complaints against health, dental, vision, mental health, and other specialized health plans.
Act as a subject matter expert and lead capacity for the Initial Review Unit.
Design, develop, and deliver training materials for the Initial Review Section.
Monitor and evaluate health program activities, ensuring compliance and effectiveness.
Collaborate with the Department’s Help Center to educate members and resolve complaints.
Minimum Requirements
Classification: Analyst II
Complete State examination or equivalent credentials as required by Class Specification.
Minimum education and experience in public health or related fields as stated in the Class Specification.
Desirable Qualifications
Knowledge of health care insurance principles, practices, and trends.
Experience in health program or operations management.
Strong organizational and prioritization skills in a fast‑paced environment.
Experience leading teams and managing high-volume caseloads.
Excellent written and oral communication skills.
Proficiency with standard office software (Teams, Outlook, Word, Excel, PowerPoint).
Ability to work independently and within a team, both remotely and in office settings.
Special Requirements
Background investigation clearance required prior to hire.
Pre‑employment background investigation, including fingerprinting and DOJ criminal record check.
Compensation Salary range: $6,031.00 – $7,547.00 per month (Classified as Analyst II). Salary may be adjusted to the minimum of alternate range for new-to-state candidates.
Benefits Benefits information available on the CalHR and CalPERS websites.
Application Instructions Submit a completed application package, including the State examination (STD Form 678) and Statement of Qualifications (SOQ). The SOQ must address how your skills and experience meet the minimum and desirable qualifications.
Equal Opportunity Employer The State of California is an equal opportunity employer. The Department of Managed Health Care celebrates diversity and provides a workplace that includes all background and personal experiences.
Contact Information Human Resources Contact: DMHC Recruitment – (916) 322‑8437, Recruitment@dmhc.ca.gov
Hiring Unit Contact: Weda Thao – (916) 255‑3894, Weda.Thao@dmhc.ca.gov
EEO Office: (916) 738‑3394, EEO@dmhc.ca.gov
Department Website: http://www.dmhc.ca.gov
#J-18808-Ljbffr
Job Summary The Initial Review Lead Analyst functions within the Initial Review Unit (IRU) under the direction of the IRU Supervisor I. The analyst will act in a lead capacity as a subject matter expert, performing case audits, screening, analysis, and triaging of Independent Medical Review (IMR) applications and incoming complaints against licensed health plans. The role also includes implementing, monitoring, and evaluating health program activities, assessing and developing training materials within the Initial Review Section (IRS).
Job Details
Job Code: JC-503931
Position Number(s): 409‑301‑5393‑139
Work Location: Sacramento County
Telework: Hybrid
Job Type: Permanent, Full Time
Number of Positions: 1
Responsibilities
Perform case audits, screening, and analysis of IMR applications.
Triage incoming complaints against health, dental, vision, mental health, and other specialized health plans.
Act as a subject matter expert and lead capacity for the Initial Review Unit.
Design, develop, and deliver training materials for the Initial Review Section.
Monitor and evaluate health program activities, ensuring compliance and effectiveness.
Collaborate with the Department’s Help Center to educate members and resolve complaints.
Minimum Requirements
Classification: Analyst II
Complete State examination or equivalent credentials as required by Class Specification.
Minimum education and experience in public health or related fields as stated in the Class Specification.
Desirable Qualifications
Knowledge of health care insurance principles, practices, and trends.
Experience in health program or operations management.
Strong organizational and prioritization skills in a fast‑paced environment.
Experience leading teams and managing high-volume caseloads.
Excellent written and oral communication skills.
Proficiency with standard office software (Teams, Outlook, Word, Excel, PowerPoint).
Ability to work independently and within a team, both remotely and in office settings.
Special Requirements
Background investigation clearance required prior to hire.
Pre‑employment background investigation, including fingerprinting and DOJ criminal record check.
Compensation Salary range: $6,031.00 – $7,547.00 per month (Classified as Analyst II). Salary may be adjusted to the minimum of alternate range for new-to-state candidates.
Benefits Benefits information available on the CalHR and CalPERS websites.
Application Instructions Submit a completed application package, including the State examination (STD Form 678) and Statement of Qualifications (SOQ). The SOQ must address how your skills and experience meet the minimum and desirable qualifications.
Equal Opportunity Employer The State of California is an equal opportunity employer. The Department of Managed Health Care celebrates diversity and provides a workplace that includes all background and personal experiences.
Contact Information Human Resources Contact: DMHC Recruitment – (916) 322‑8437, Recruitment@dmhc.ca.gov
Hiring Unit Contact: Weda Thao – (916) 255‑3894, Weda.Thao@dmhc.ca.gov
EEO Office: (916) 738‑3394, EEO@dmhc.ca.gov
Department Website: http://www.dmhc.ca.gov
#J-18808-Ljbffr