Managed Care Organization (MCO) Program Integrity Consultant /Human Services Program Representative 2

Minnesota Direct Care and Treatment; Saint-Paul; On-site; CAD 96,000 - 142,000; Full time

Benefits offered by this job

Paid vacation and sick leave

12 paid holidays each year

Pension plan

Job summary

The Minnesota Department of Human Services is seeking a Temporary Unclassified MCO Program Integrity Consultant to design and conduct focused monitoring and auditing of MCO compliance with program integrity requirements. The role involves acting as a technical expert, coordinating with MCOs and DHS partners to address deficiencies and implement corrective actions.

Applicants should have experience in health care fraud, waste and abuse programs, and the ability to develop performance metrics.

Qualifications

• Experience in monitoring, auditing and overseeing activities related to program compliance.
• Ability to assess integrity program effectiveness and recommend solutions.
• Ability to format, analyze, and/or prepare computer generated reports containing narrative and numeric data.

Responsibilities

• Plan, design, develop, conduct, and report on results of focused monitoring and auditing of MCO compliance with program integrity requirements.
• Serve as a technical expert on MCO program integrity requirements and compliance monitoring to advise division leadership and coordinate engagements with MCOs.
• Evaluate and report on MCO compliance with federal rules, Minnesota statute and rules, and DHS policies, and in accordance with contracts.
• Serve as a liaison between the OIG and Program Integrity Oversight Division and the MCO SIUs and Partners.

Skills

Health care fraud knowledge

Program integrity knowledge

Analytical skills

Tools

Microsoft Word

Excel

Job description

• Telework Eligible: Yes
• Working Title: Managed Care Organization (MCO) Program Integrity Consultant
• Job Class: Human Services Program Representative 2
• Agency: Human Services Dept
• Job ID: 97034
• Location: St. Paul
• Telework Eligible: Yes
• Full/Part Time: Full-Time
• Regular/Temporary: Limited
• Who May Apply: Open to all qualified job seekers
• Date Posted: 09/15/2026
• Closing Date: 09/28/2026
• Hiring Agency/Seniority Unit: Human Services Dept / MAPE DHS Central Office
• Division/Unit: Department of Human Services (DHS) / Office of Inspector General (OIG)-PIO POAI MCO Unit
• Work Shift/Work Hours: Day Shift / 8:00 a.m. - 4:30 p.m.
• Days of Work: Monday - Friday
• Travel Required: Yes
• Salary Range: $32.97 - $48.60 / hourly; $68,841 - $101,476 / annually
• Classified Status: Unclassified
• Bargaining Unit/Union: 214 - MN Assoc of Professional Empl/MAPE
• End Date: 10/14/2029
• FLSA Status: Nonexempt
• 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.

• 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.
• Up to 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 of the Temporary Unclassified MCO Program Integrity Consultant include but are not limited to:

• Plan, design, develop, conduct, and report on results of focused monitoring and auditing of MCO compliance with program integrity requirements, and coordinate compliance and corrective action when deficiencies are identified.
• Serve as a technical expert on MCO program integrity requirements and compliance monitoring to advise division leadership, propose strategies and coordinate engagements with MCOs.
• 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.
• Serve as a key liaison between the OIG and Program Integrity Oversight Division (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.

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 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

This position requires successful completion of the following:

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.

About Human Services Dept

WE MAKE A DIFFERENCE! The Minnesota Department of Human Services impacts the lives of 1.7 million people every year, helping them meet their basic needs so they can achieve their highest potential.

Working together to improve the state we love.

What do Minnesota's State employees have in common?

• A sense of purpose in their work
• Connection with their coworkers and communities
• Opportunities for personal and professional growth

Benefits

As an employee, you'll have access to one of the most affordable health insurance plans in Minnesota, along with other benefits to help you and your family be well.

Your Benefits May Include

• Paid vacation and sick leave
• 12 paid holidays each year
• Low-cost medical, dental, vision, and prescription drug plans
• Fertility care, including IVF
• Diabetes care
• Dental and orthodontic care for adults and children
• 6 weeks paid leave for parents of newborn or newly adopted children
• Pension plan that provides income when you retire (after working at least three years)
• Employer paid life insurance to provide support for your family in the event of death
• Short-term and long-term disability insurance that can provide income if you are unable to work due to illness or injury
• Tax-free expense accounts for health, dental, and dependent care
• Resources that provide support and promote physical, emotional, social, and financial well-being

Support To Help You Reach Your Career Goals

• Training, classes, and professional development
• Tuition reimbursement
• Federal Public Service Loan Forgiveness Program (Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, visit the Federal Student Aid website at studentaid.gov)

Employee Assistance Program (EAP) For Work/life Support

• A voluntary confidential program that helps employees and their families with life challenges that may impact overall health, personal well-being, or job performance
• Common sources of stress can be addressed through the EAP: mental health, relationship challenges (personal and work), grief and loss, finances, and legal issues
• Daily Living/Convenience Services: Chore services, home repair, trip planning, child/elder care

Programs, resources and benefits eligibility varies based on type of employment, agency, funding availability, union/collective bargaining agreement, location, and length of service with the State of Minnesota.

EQUAL OPPORTUNITY EMPLOYERS

Minnesota state agencies are equal opportunity, affirmative action, and veteran-friendly employers. State agencies are committed to creating a workforce that reflects the diversity of the state and strongly encourages persons of color and Indigenous communities, members of the LGBTQIA2S+ community, individuals with disabilities, women, and veterans to apply. The varied experiences and perspectives of employees strengthen the work we do together and our ability to best serve Minnesotans.

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, national origin, sex (including pregnancy, childbirth, and disabilities related to pregnancy or childbirth), gender identity, gender expression, marital status, familial status, age, sexual orientation, status regarding public assistance, disability, veteran status or activity in a local Human Rights Commission or any other characteristic protected by law.

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 [e-mail] and let us know the support you need.