Medicaid Program Integrity Review Supervisor - Human Services Supervisor 2

State of Minnesota; Saint Paul (MN); Ibrido; USD 72.000 - 105.000; Tempo pieno

Descrizione del lavoro

The State of Minnesota seeks a Medicaid Program Integrity Review Supervisor to lead the Behavioral Health Administration’s payment integrity efforts, oversee a five-person team, and coordinate CMS focused reviews. This role requires clinical and policy review expertise and strong leadership within a statewide Medicaid context.

You will drive program expansion, ensure compliance with data practices, and advise leadership on policy changes to close program vulnerabilities.

Competenze

• Demonstrated leadership experience in supervisory roles.
• Three (3) years of advanced-level work experience conducting clinical and policy reviews of Medicaid services.
• In-depth knowledge of Minnesota's behavioral health service delivery system and Medicaid rules.
• Hands-on experience with program integrity review methods including prepayment and focused reviews.

Mansioni

• Direct BHA's Medicaid payment integrity review program across SUD, mental health, and integrated services, setting goals and strategy.
• Exercise supervisory authority to ensure labor agreements are administered and staff duties are met to achieve unit objectives.
• Lead planning and expansion of Medicaid program integrity review across BHA and shape policy and legislative framework.
• Serve as BHA's operational lead for CMS focused review activity and liaise with DHS, CMS and external partners.
• Direct unit quality assurance, review targeting, and performance measurement with the data analytics team.
• Ensure program records, appeals support, and data handling meet audit and data practices requirements.

Conoscenze

Leadership experience

Supervisory experience

Policy review experience

Clinical review experience

Data analytics awareness

Formazione

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

Master’s degree may substitute for two years of experience

Descrizione del lavoro

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 (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 (https://mn.gov/mmb-stat/policies/1422-telework.pdf) 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

Three (3) years of advanced-level work experience conducting clinical and policy reviews of Medicaid services within a human services program.

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 MinnesotaDepartmentofHumanServices(DHS) will conduct criminalbackgroundchecksonallfinalistsforthis position.Finalistsmustpassthe DHS backgroundcheck.

• Employee reference checks will be conducted on all finalists. This may include a review of documentation related to jobperformance.It alsoincludescontact withtheapplicant'sformer employer(s).

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 [e-mail] . Please indicate what assistance is needed.