Departmental Analyst 12 (Senior MCO Analyst) - Managed Care Oversight Unit - MDHHS OIG

State of Michigan; Lansing (MI); Hybride; USD 65 000 - 95 000; Plein temps

Résumé du poste

The Michigan Department of Health and Human Services (MDHHS) Office of Inspector General seeks a Senior Managed Care Oversight Analyst to review complex Medicaid Managed Care Entities and MI Choice Waiver Agencies for fraud, waste and abuse. You will advise on regulatory changes, develop oversight tools, and conduct annual contract reviews.

Position requires a bachelor’s degree and substantial professional experience in accounting or managed care, with stringent background checks and the ability

Qualifications

• Bachelor’s degree in any major required.
• Three years of professional experience, including one year at the P11 level in state service.
• Preferred experience in accounting, auditing, managed care, and Medicaid or similar health services.

Responsabilités

• Investigates the most complex activities and submissions by Medicaid Managed Care Entities and MI Choice Waiver Agencies for fraud, waste and abuse.
• Advises on interpretation of regulatory changes and develops/updates oversight tools to evaluate program integrity.
• Conducts annual contract reviews and monitors corrective action plans, sanctions and penalties.
• Provides guidance on regulatory changes and state-wide impact of managed care oversight.

Formation

Bachelor's degree in any major

Description du poste

The MDHHS mission is to provide opportunities, services, and programs that promote a healthy, safe, and stable environment for residents to be self-sufficient. We are committed to ensuring a diverse workforce and a work environment whereby all employees are treated with dignity, respect and fairness. For more information, please visit our MDHHS Diversity, Equity, and Inclusion Plan.

Office of Inspector General (OIG) - Career Brochure

This position functions as a Senior Managed Care Oversight Analyst within the Michigan Department of Health and Human Services (MDHHS) Office of Inspector General (OIG). The MDHHS OIG is a criminal justice agency housed within MDHHS charged with investigating fraud, waste and abuse in programs administered by MDHHS and increasing program integrity and accountability.

The Senior Analyst reviews and investigates the most complex activities and submissions of Medicaid Managed Care Entities (MCEs) and MI Choice Waiver Agencies in relation to fraud, waste, and abuse. Ensures compliance with program integrity requirements through identification and resolution of deficiencies, Credible Allegations of Fraud (CAF), and issues and monitors corrective action plans, sanctions, and penalties of the MCEs including, but not limited to Medicaid Health Plans (MHPs), Prepaid Inpatient Health Plans (PIHPs), Non-Emergency Medical Transportation (NEMT) plan, MI Choice Waiver Agencies, and Dental plans, all of which are responsible for managing certain aspects of health care for Medicaid beneficiaries enrolled in their managed care entities.

The Senior Analyst advises and provides guidance on the interpretation of regulatory changes, develops and updates managed care oversight tools to evaluate, track and monitor program integrity and statewide impact, and conducts annual contract reviews.

Position Description & Job Specification.

Education

Possession of a bachelor's degree in any major.

Experience

Departmental Analyst 12 - Three years of professional experience, including one year of experience equivalent to the experienced (P11) level in state service.

Preferred experience in accounting and auditing, managed care, and Medicaid or similar health services program. Experience developing and maintaining policy, procedure and guidelines for highly complex functional areas based on broad and nonspecific operational criteria.

Alternative Education and Experience

Departmental Analyst 9 - 12 Educational level typically acquired through completion of high school and the equivalent of at least two years of full-time active-duty experience at or above the E-6 level in the uniformed services may be substituted for the education requirement.

The use of artificial intelligence (AI) software of any kind is prohibited in all areas of the selection process; including, but not limited to, responses to application questions, and responses to interview questions or exercises.

If you previously held status in this classification and departed within the last three (3) years, please contact Human Resources regarding your interest in a potential reinstatement. Reinstatement is not guaranteed or required.

Your application for any position does not guarantee you will be contacted by the Department/Agency for further consideration. Only those applicants interviewed will be notified of the results.

Position Location/Remote Office

The physical location of this position will be based on the county of the selected candidate however, the position's official worksite is at 235 S. Grand Ave., Lansing, MI 48933. Based on operational needs and within established limits, remote work and alternate or hybrid work schedule requests for this position may be considered. Selected candidates who have been approved to work remotely or a hybrid schedule must complete that work within Michigan. Candidates should confirm work location and schedule at the time of interview.

Employees will be provided computers to perform state work. Phones may also be provided for necessary communications. If working remotely, employees will be responsible for providing other components of a remote office at their own expense, including:

• A secure work location that allows privacy and prevents distractions.
• A high-speed internet connection of at least 25 Mbps download and 5 Mbps upload.
• Suitable lighting, furniture, and utilities.

As a Condition of Employment

This position requires successful completion of a background investigation and a criminal records check.

Due to the nature of this position, an additional extensive background check will be conducted on candidates being considered for the vacancy.

The Department of Health and Human Services reserves the right to close this posting prior to its original end date once a sufficient number of applications have been received.

For information about the specific position, please email [e-mail]. Please reference the job posting number in subject line.

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