Working Title: Managed Care Outcomes Coordinator
Job Class: Human Services Program Representative 2
Agency: Human Services Dept
Job ID : 87867
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 : 07/29/2025
Closing Date : 08/04/2025
Hiring Agency/Seniority Unit : Human Services Dept / MAPE DHS Central Office
Division/Unit : Health Care Administration / Purchasing and Service Delivery
Work Shift/Work Hours : Day Shift / 8:00am - 4:30pm
Days of Work : Monday - Friday
Travel Required : No
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 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 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.
The Managed Care Outcomes Coordinator is responsible for managed care organization (MCO) performance assessment, implementation of a new state monitoring system, identification, establishment, and coordination of all aspects of a MCO's performance. This position develops policy parameters for reports that ensures MCO compliance and adherence to contract performance that includes administration and management, client appeals and grievance systems, enrollee and provider communications, member service and outreach, benefit marketing, provider availability and network adequacy, program management and integrity, client ease of access including utilization management and case management, quality assurance and improvements, claims management, long term services and supports, and other reporting provisions as required.
This position is responsible for:
Establish MCO performance standards to ensure compliance parameters as established by state, federal, and contractual requirements,
Establish compliance rules for meeting performance for all Managed Care Programs,
Develop and lead information and data gathering for state monitoring report,
Analyze and interpret data for monitoring report findings,
Create the Managed Care State Monitoring Report,
Serve as subject matter expert in establishing policies and procedures to ensure DHS is maximizing federal funding for the managed care program,
Serve as liaison to the Healthcare Research and Quality (HRQ) division regarding the development and oversight of managed care quality initiatives,
Create managed care related reports for internal and external stakeholders including the Governor, Commissioner, Legislature and the public,
Coordinate external data requests related to managed care activity,
Manage MCO and CBP reports and reporting requirements,
Work with DHS federal relations on meeting the goals of the Access Review Monitoring Plan,
Serve as managed care representative on the implementation and ongoing operations of the beneficiary support system,
Develop and make policy recommendations for Managed Care contract language.
Minimum Qualifications
Three (3) years professional Minnesota Health Care Programs experience, with expertise in at least two of the following:
Medical Assistance (MA),
MinnesotaCare,
Minnesota Senior Care Plus (MSC+),
Minnesota Senior Health Options (MSHO) or
Special Needs BasicCare (SNBC)
Experience must demonstrate:
Ensuring compliance with Federal and state laws governing managed care and fee-for-service health care programs.
Experience with managed care concepts, health care purchasing, incentives, risk-based contracting, rates development, cost sharing, quality assurance and quality management principles.
Research techniques, data collection, monitoring and analysis.
Bachelor's Degree in Health Policy, Human Services, Business Administration or related field may substitute for 1 year of experience OR Master's degree in Health Policy, Human Services, Business Administration or related field may substitute for 2 years of experience
Preferred Qualifications
Planning and development of human service program delivery and evaluation.
Principles and application of legislative and budgetary analysis.
Federal, state, and other managed care quality initiatives.
State and federal eligibility requirements.
State and federal report writing.
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.
