Working Title: Managed Care Organization (MCO) Program Integrity Consultant
Job Class: Human Services Program Representative 2
Agency: Human Services Dept
Job ID : 87482
Location : St. Paul
Telework Eligible : Yes
Full/Part Time : Full-Time
Regular/Temporary : Unlimited
Who May Apply : Open to all qualified job seekers
Date Posted : 07/11/2025
Closing Date : 07/24/2025
Hiring Agency/Seniority Unit : Human Services Dept / MAPE DHS Central Office
Division/Unit : Department of Human Services (DHS) / Office of Inspector General (OIG) FFAID MCO Oversight
Work Shift/Work Hours : Day Shift / 8:00 a.m. - 4:30 p.m.
Days of Work : Monday - Friday
Travel Required : Yes
Salary Range: $31.92 - $47.05 / hourly; $66,648 - $98,240 / annually
Classified Status : Classified
Bargaining Unit/Union : 214 - MN Assoc of Professional Empl/MAPE
FLSA Status : Nonexempt
Designated in Connect 700 Program for Applicants with Disabilities (https://mn.gov/mmb/careers/diverse-workforce/people-with-disabilities/connect700/) : 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.
*This position is eligible for telework (https://mn.gov/mmb-stat/policies/1422-telework.pdf) 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 rule and as a condition of contracting with the State of Minnesota to conduct a variety of program integrity activities and establish Special Investigations Units (SIUs) that conduct specific activities designed to prevent, detect and respond to fraud, waste, abuse and noncompliance with certain contractual or other regulatory requirements that results in improper payments. In turn, the State of Minnesota, through its Office of Inspector General (OIG), is required to ensure that MCOs implement and maintain effective integrity programs designed to detect and prevent fraud, waste, and abuse in the Medical Assistance (MA) program.
Responsibilities include but are not limited to the following:
Plan, design, develop, conduct, and report on results of focused monitoring and auditing of MCO compliance with program integrity requirements
Enforce accountability when deficiencies are identified.
Serve as a technical expert on MCO program integrity requirements and compliance monitoring to advise division leadership, proposing strategies and coordinating engagements with MCOs.
Act as a key liaison between the Office of Inspector General (OIG) / Program Integrity Oversight (PIO) and the MCO SIUs and Restricted Recipient Programs, as well as state and federal partners such as the MN Attorney General's Office, Office of Legislative Auditor, Department of Health, and Centers for Medicaid and Medicare Services.
Evaluate and report on MCO compliance with federal rules, Minnesota statute and rules, and Department of Human Services (DHS) policies, and in accordance with their contracts.
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.
Three (3) years of experience monitoring, auditing and overseeing activities related to program compliance.
Experience must demonstrate the following:
Knowledge of the health care fraud, waste and abuse, as well as program integrity and anti-fraud initiatives.
Assess integrity program effectiveness and recommend solutions.
Format, analyze, and/or prepare computer generated reports containing narrative and numeric data.
Develop and track quality and performance metrics for the monitoring and audit program.
Preferred Qualifications
Knowledge of the Minnesota Medicaid Information System (MMIS) as well as benefit administration systems used by the Managed Care plans.
Understanding of Minnesota Health Care Programs (MHCP), and specifically Medicaid (Medical Assistance).
Knowledge of Federal oversight authority of the Medicaid program, as it relates to both Fee-For-Service (FFS) and Managed Care, and an understanding of the State's role in administering Medicaid to assure compliance with federal mandate.
Knowledge of data and systems used in MCO program integrity and anti-fraud environments
Coordinate and direct the work of others, as well as develop presentations and educational materials sufficient to influence, train, or motivate individuals and groups.
Strong analytical, problem solving, and organizational skills with the ability to produce and measure performance and results.
Working knowledge of Microsoft Word, Excel, and basic computer programs.
Variety of experiences working effectively with others from different backgrounds and cultures.
Additional Requirements
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.
REFERENCE/BACKGROUND CHECKS - The Department of Human Services will conduct reference checks to verify job-related credentials and criminal background check prior to appointment.
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.
