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

State of Michigan; Michigan; Hybrid; USD 65,000 - 90,000; Full time

Job summary

The State of Michigan, in the MDHHS Office of Inspector General, seeks a Senior Managed Care Oversight Analyst to investigate and oversee Medicaid managed care entities. The role focuses on compliance, fraud, waste and abuse, and the development of oversight tools and contract reviews.

Candidate will interpret regulatory changes and guide program integrity statewide. Based in Michigan with potential hybrid/remote options, the position requires a bachelor’s degree and several years of state-level

Qualifications

• Bachelor's degree in any major.

Responsibilities

• Reviews and investigates the most complex activities and submissions related to Medicaid Managed Care Entities (MCEs) and MI Choice Waiver Agencies.
• Advises and provides guidance on regulatory changes; develops and updates oversight tools to evaluate and monitor program integrity.
• Conducts annual contract reviews and monitors corrective action plans, sanctions, and penalties for MCEs.

Education

Bachelor's degree

Job description

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.

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.

Click here to view the Position Description & here to view the 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].

MDHHS is proud to be a Michigan Veteran's Affairs Agency (MVAA) Gold Level Veteran-Friendly Employer.