JOB SUMMARY

• 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.
• Approximately 10% travel.
  Minnesota’s contracted Managed Care Organizations (MCOs) are required by federal regulation, and as a condition of their contracts with the State, to conduct robust program integrity activities. These include establishing Special Investigations Units (SIUs) to prevent, detect, and respond to fraud, waste, abuse, and noncompliance that may result in improper payments.
  The State of Minnesota, through its Office of Inspector General (OIG), is responsible for ensuring that MCOs implement and maintain effective integrity programs within the Medical Assistance (MA) program.
  This position plays a critical role in safeguarding the integrity of Minnesota’s Medicaid programs. The incumbent work closely with internal teams, MCOs, and external partners to identify and respond to potential fraud, waste, and abuse. The incumbent’s insights will help shape policy, improve oversight, and ensure that public resources are used appropriately.

Key responsibilities include (but are not limited to):

• Planning, designing, conducting, and reporting on focused monitoring and audits of MCO compliance with program integrity requirements.
• Enforcing accountability when deficiencies are identified.
• Serving as a technical expert on MCO program integrity and compliance monitoring, advising division leadership and coordinating strategic engagements with MCOs.
• Acting as a liaison between the OIG/Program Integrity Oversight (PIO) and MCO SIUs, Restricted Recipient Programs, and external partners such as the MN Attorney General’s Office, Office of Legislative Auditor, Department of Health, and Centers for Medicare & Medicaid Services (CMS).
• Evaluating and reporting on MCO compliance with federal regulations, Minnesota statutes and rules, DHS policies, and contractual obligations.

*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.*

Three (3) years of professional experience in monitoring, auditing, or overseeing activities related to program compliance within a Managed Care Organization (MCO), Medicaid program, or health benefits administration setting.

Experience must demonstrate:

• Direct involvement in health care fraud, waste, and abuse (FWA) investigations, program integrity, or anti-fraud initiatives.
• Ability to assess program integrity effectiveness and recommend actionable solutions.
• Experience formatting, analyzing, and preparing reports containing both narrative and numeric data.
• Development and tracking of quality and performance metrics for monitoring and audit programs.

PREFERRED QUALIFICATIONS

• Knowledge of the Minnesota Medicaid Information System (MMIS) and benefit administration systems used by Managed Care plans.
• Understanding of Minnesota Health Care Programs (MHCP), especially Medical Assistance (Medicaid).
• Familiarity with Federal oversight of Medicaid, including both Fee-For-Service (FFS) and Managed Care, and the State’s role in ensuring compliance with federal mandates.
• Experience working with data and systems used in MCO program integrity and anti-fraud environments, including SIU (Special Investigations Unit) tools and reporting systems.
• Ability to coordinate and direct the work of others, and develop presentations or educational materials to influence, train, or motivate individuals and groups.
• Strong analytical, problem-solving, and organizational skills with a proven ability to measure performance and results.
• Proficiency in Microsoft Word, Excel, and other basic computer programs.
• Demonstrated ability to work effectively with individuals from diverse backgrounds and cultures.

ADDITIONAL REQUIREMENTS

It is the policy of the Department of Human Services that the individual selected for this position successfully complete a background investigation prior to employment, including the following components:

• 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.

APPLICANTS WITH DISABILITIES

Minnesota state agencies make reasonable accommodations to their employees and applicants with disabilities. If you have a disability and need assistance in searching or applying for jobs with the State of Minnesota, call the Careers Help Desk at 651-259-3637 or email careers@state.mn.us and let us know the support you need

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.

Key responsibilities include (but are not limited to):

• Planning, designing, conducting, and reporting on focused monitoring and audits of MCO compliance with program integrity requirements.
• Enforcing accountability when deficiencies are identified.
• Serving as a technical expert on MCO program integrity and compliance monitoring, advising division leadership and coordinating strategic engagements with MCOs.
• Acting as a liaison between the OIG/Program Integrity Oversight (PIO) and MCO SIUs, Restricted Recipient Programs, and external partners such as the MN Attorney General’s Office, Office of Legislative Auditor, Department of Health, and Centers for Medicare & Medicaid Services (CMS).
• Evaluating and reporting on MCO compliance with federal regulations, Minnesota statutes and rules, DHS policies, and contractual obligations