Medicaid Provider Audits And Investigations Manager / Human Services Manager 2

Medicaid Provider Audits And Investigations Manager

Job Class: Human Services Manager 2

Agency: Human Services Department

Location: St. Paul

Telework Eligible: Yes

Full/Part Time: Full-Time

Regular/Temporary: Unlimited

Who May Apply: Open to all qualified job seekers

Salary Range: $43.38 - $62.41 / hourly; $90,577 - $130,312 / annually

Classified Status: Classified

Bargaining Unit/Union: 220 - Manager/Unrep

FLSA Status: Exempt - Executive

Designated in Connect 700 Program for Applicants with Disabilities: Yes

The Department of Human Services (DHS) is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify.

The work you'll do is more than just a job. At the State of Minnesota, employees play a critical role in developing policies, providing essential services, and working to improve the well-being and quality of life for all Minnesotans. The State of Minnesota is committed to equity and inclusion, and invests in employees by providing benefits, support resources, and training and development opportunities.

Approximately, 5% travel. This position is eligible for telework for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework.

Under the general direction of the Deputy Inspector General, this position provides executive leadership and strategic oversight of health care program integrity within Minnesota's Medicaid system. The incumbent manages anti-fraud, waste, and abuse efforts, including provider investigations, prevention, education, and enforcement activities. Responsibilities include but are not limited to:

• Developing and implementing investigative protocols to ensure payment integrity and legitimacy of services provided to public clients.
• Strategic planning, policy development, collaboration with federal and state partners, and oversight of case management systems.
• Supports legislative and budget initiatives, ensures regulatory compliance, and uses data analytics to guide interventions that enhance care delivery, payment accuracy, and overall Department of Human Services (DHS) performance.

Minimum Qualifications

To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month and year for each job held.

Demonstrated leadership experience:

• Experience as a supervisor, lead worker, team lead, project lead;
• Completion of a State of Minnesota leadership program (e.g. ELI, L4);
• A paid/unpaid position leading a program or chairing a committee (e.g. ERG) - experience must include:
• 1+ year of experience identifying issues, goals and strategic actions
• 100+ hours per year time commitment
• AND Five (5) years of experience managing investigations and prosecutions related to human services programs and particularly Medicaid or Minnesota Health Care Programs.
• AND Experience must demonstrate the following:
• Knowledge of health care issues surrounding fraud and abuse by providers.
• Develop compliance, investigative, surveillance, analysis, training models and/or toolsets used to determine trends in fraudulent or abusive provider practices.
• Lead continued system development to meet investigative needs and legal requirements.
• Develop, implement, evaluate, and alter administrative processes.

Preferred Qualifications

Development of program integrity activities on the local and national levels. Knowledge of Minnesota's fee-for-service and managed care health care delivery systems, payment mechanisms, and costs. Understanding of legislative processes, documents and procedures Design and implement specific written protocols investigations of all provider types. Plan and implement policy, program, operations, and budget changes. Understands the theories behind, policy issues surrounding, and current applications of reimbursement methodologies and systems used to reimburse health care services. Understand automated systems and data communications technology to support DHS reporting, accountability, and strategic planning activities. Variety of experiences working effectively with others from different backgrounds and cultures.

Additional Requirements

This position requires successful completion of the following:

• Criminal background check
• Reference check
• Fingerprinting check (MNJIS/CJIS)
• Complete the Criminal Justice Information System (CJIS) Security Awareness training within 3-business days from the start of employment; and successfully obtain/retain CJIS certification annually.

AN EQUAL OPPORTUNITY EMPLOYER Minnesota State Colleges and Universities is an Equal Opportunity employer/educator committed to the principles of diversity. We prohibit discrimination against qualified individuals based on their race, sex, color, creed, religion, age, national origin, disability, protected veteran status, marital status, status with regard to public assistance, sexual orientation, gender identity, gender expression, or membership in a local commission as defined by law. As an affirmative action employer, we actively seek and encourage applications from women, minorities, persons with disabilities, and individuals with protected veteran status. Reasonable accommodations will be made to all qualified applicants with disabilities. If you are an individual with a disability who needs assistance or cannot access the online job application system, please contact the job information line at 651-259-3637 or email careers@state.mn.us. Please indicate what assistance is needed.