Medicaid Program Integrity Review Supervisor - Human Services Supervisor 2

Minnesota Direct Care and Treatment; Saint-Paul; Hybrid; CAD 102,000 - 148,000; Full time

Job summary

The Minnesota Department of Human Services seeks a Medicaid Program Integrity Review Supervisor to lead the Behavioral Health Administration's payment integrity program for SUD, mental health, and integrated services. You will supervise five analysts, set review goals, and coordinate CMS-focused reviews with DHS and external partners.

The role supports prepayment and focused review activities, ensures compliance with data practices, and works within day shift hours, with potential telework for

Qualifications

• Experience as a supervisor, lead worker, team lead, or project lead.
• Completion of a State leadership program (e.g., ELI, L4).
• Experience leading a program or chairing a committee (e.g., ERG) with at least 1 year of issue identification and 100 hours/year commitment.
• Knowledge of Minnesota's behavioral health service delivery system and Medicaid program integrity requirements.
• Hands-on experience with prepayment and focused reviews and fraud, waste, and abuse referral.
• Bachelor's or Master's can substitute years of experience as specified.

Responsibilities

• Direct BHA's Medicaid payment integrity review program across SUD, mental health, and integrated services, establishing program goals, standards, and review strategy.
• Exercise supervisory authority so that applicable labor agreements and plans are equitably administered and assigned employees effectively perform assigned job duties to achieve the annual objectives of the unit.
• Lead the planning, development, and implementation of the expansion of Medicaid program integrity review across BHA, and shape the policy, rule, and legislative framework that supports it.
• Serve as BHA's operational lead for CMS focused review activity and represent the payment integrity program with DHS administrations, OIG, and external partners.
• Direct unit quality assurance, review targeting, and performance measurement in coordination with the BHA data analytics team.
• Ensure program records, appeals support, and data handling meet audit, legal, and data practices requirements.

Skills

Leadership

Communication

Program integrity knowledge

Project management

Education

Bachelor's degree in healthcare administration, social work, mental health, or related field

Master’s degree in healthcare administration, social work, mental health, or related field

Tools

Medicaid claims platforms

Electronic Health Record (EHR) systems

Reporting tools

Job description

• Telework Eligible: Yes

Working Title: Medicaid Program Integrity Review Supervisor

Job Class: Human Services Supervisor 2

Agency: Human Services Dept

• Job ID: 98254
• 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: 11/06/2026
• Closing Date: 11/20/2026
• Hiring Agency/Seniority Unit: Human Services Dept / DHS Central Office MMA
• Division/Unit: DHS-Central Office / BHA Program Integrity
• Work Shift/Work Hours: Day Shift / 8:00am to 4:30pm
• Days of Work: Monday - Friday
• Travel Required: yes,(20% for meetings)
• Salary Range: $34.71 - $50.25 / hourly; $72,474 - $104,922 / annually
• Classified Status: Classified
• Bargaining Unit/Union: 216 - Middle Management Association/MMA
• FLSA Status: Exempt - Executive
• Designated in Connect 700 Program for Applicants with Disabilities: 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.

Flexible work hours may be permitted with supervisor approval.

This position exists to direct the Behavioral Health Administration's (BHA) Medicaid payment integrity program for behavioral health services. The incumbent integrates clinical review, policy interpretation, data analytics, and cross‑administration compliance activities into a single program that determines whether Medicaid claims for substance use disorder (SUD), mental health, and integrated behavioral health services are allowable, medically necessary, and properly paid. The program's core activities are prepayment review of claims from providers and services identified as high‑risk, and Centers for Medicare & Medicaid Services (CMS)–directed focused review of questionable claims.

The incumbent supervises a team of five (5) Medicaid Payment Integrity Policy Analysts who serve as the program's clinical and policy subject matter experts. The incumbent sets the program's goals, standards, and review strategy; leads the planned expansion of program integrity review across BHA's Medicaid‑funded service array; serves as BHA's operational lead for CMS focused review activity; and advises BHA leadership on policy, rule, and legislative changes needed to close program vulnerabilities.

The position works under administrative direction from the Program Integrity & Continuity of Care Manager and is evaluated on results. Its work protects the fiscal integrity of Minnesota's Medicaid behavioral health programs and the state's standing with CMS, while preserving recipient access to medically necessary care.

Key Responsibilities Will Include

• Direct BHA's Medicaid payment integrity review program—including prepayment review and CMS‑directed focused review—across SUD, mental health, and integrated services, establishing program goals, standards, and review strategy and exercising final unit‑level authority on complex determinations.
• Exercise supervisory authority so that applicable labor agreements and plans are equitably administered and assigned employees effectively perform assigned job duties to achieve the annual objectives of the unit.
• Lead the planning, development, and implementation of the expansion of Medicaid program integrity review across BHA, and shape the policy, rule, and legislative framework that supports it.
• Serve as BHA's operational lead for CMS focused review activity and represent the payment integrity program with DHS administrations, OIG, and external partners.
• Direct unit quality assurance, review targeting, and performance measurement in coordination with the BHA data analytics team.
• Ensure program records, appeals support, and data handling meet audit, legal, and data practices requirements.

All DHS Leaders are expected to demonstrate and develop the five (5) competency themes from the Enterprise‑wide Leader Competency Model:

• Leading Self
• Leading Others
• Leading the Organization
• Leading Outside the Organization
• Getting Work Done

Minimum Qualifications

To be considered, your resume must clearly describe your experience in the areas below, including the start and end month/year for each position held.

Demonstrated Leadership Experience. Leadership Experience Can Include

• 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 commitment

AND

This Experience Must Demonstrate

• Minnesota's behavioral health service delivery system across SUD, mental health, and integrated services, including service standards and documentation requirements under Minnesota Statutes chapters 245G, 245I, 254B, and 256B.
• Medicaid program integrity requirements and methods, including prepayment and focused claims review, improper payment identification, risk‑based targeting, payment withholds, and fraud, waste, and abuse referral (including 42 CFR Parts 455 and 456).
• Medicaid coverage, medical necessity, State Plan, claims processing, rate methodology, and behavioral health coding and billing.
• In-depth knowledge of Medicaid program rules, medical necessity criteria, and clinical documentation standards for behavioral health services.
• Hands‑on experience with program integrity review methods — including prepayment review, focused claims review, and provider recertification review.
• Bachelor’s degree in healthcare administration, social work, mental health, or a related field may substitute for one (1) year of experience.
• Master’s degree in healthcare administration, social work, mental health, or a related field may substitute for two (2) years of experience.

Preferred Qualifications

• Variety of experiences working effectively with people from backgrounds and cultures different than one’s own.
• Strong communication skills — able to explain complex topics clearly, both in writing and in conversation, and to listen and respond openly to team members’ questions and concerns.
• Knowledge of supervisory practices, including workload management, coaching, performance feedback, and corrective action.
• Certification as a Program Integrity Professional (CPIP) or in Healthcare Compliance.
• Experience working with Medicaid claims platforms, electronic health record (EHR) systems, or reporting tools.
• Ability to identify patterns or trends in review findings that may signal systemic documentation issues or provider compliance concerns.
• Program planning and evaluation, quality assurance methods, and claims data analytics.
• The ASAM Criteria and level‑of‑care standards for mental health and co‑occurring conditions.
• Program planning and evaluation, quality assurance methods, and claims data analytics.

Additional Requirements

• The Minnesota Department of Human Services (DHS) will conduct criminal background checks on all finalists for this position. Finalists must pass the DHS background check.
• Employee reference checks will be conducted on all finalists. This may include a review of documentation related to job performance. It also includes contact with the applicant's former employer(s).

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

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.