RESEARCH DATA MANAGER

The Research Data Manager (RDM) leads enterprise-level fraud analytics and data research that guide strategic enforcement priorities, optimizes the Division of Medi-Cal Fraud & Elder Abuse (DMFEA) performance, and identifies systemic fraud and elder abuse risks across California’s Medicaid system. The RDM leads teams that apply advanced statistical methods, big data analysis, and program policy evaluation to identify fraudulent billing patterns, assess systemic risks within Medi-Cal that may indicate potential for fraud or patient harm, and evaluate DMFEA internal workflow effectiveness. By establishing research priorities, developing methodologies, and translating data into actionable intelligence for field-based investigations staff, the RDM ensures DMFEA leadership has the information necessary to guide investigative strategies, allocate resources effectively, and strengthen prosecutions. The RDM serves as a consultant to the DMFEA Executive Office, including the Chief Assistant Attorney General, regarding the assessment of global fraud risks, high-priority investigations, resource management, and project timelines and milestones. The RDM represents the Division in a wide variety of specialized and complex subject areas having a significant impact on the Medi-Cal system and Division, and may personally handle the most complex functions of the unit. Desirable Qualifications In addition to evaluating each candidate's relative ability, as demonstrated by quality and breadth of experience, the following factors will provide the basis for competitively evaluating each candidate: The Research Data Manager oversees the strategic utilization of Medi-Cal claims systems, including SURS Prospector, Business Objects, MIS/DSS, and the Drug Utilization Review (DUR) program, while serving as a subject matter expert on National Drug Codes (NDC), CPT, and ICD coding standards. The incumbent directs the implementation of advanced analytical workflows using SAS and Microsoft Office to drive data-driven decision-making. They are responsible for synthesizing complex data into high-level executive reports and briefings, demonstrating superior communication skills, and fostering a high-performance team environment through effective mentorship and cross-departmental leadership. #J-18808-Ljbffr State of California