Medicaid Program Integrity Specialist – Long-Term Care

Nebraska Department of Health and Human Services; Lincoln (NE); On-site; USD 28,000 - 40,000; Full time

Benefits offered by this job

Health insurance

Retirement plan

Job summary

Nebraska Department of Health and Human Services in Lincoln, NE seeks a Program Integrity Specialist for Medicaid and Long-Term Care to lead program integrity efforts. The role focuses on expert knowledge of regulations, HCBS requirements, and ensuring use of the electronic visit verification system.

Responsibilities include policy development, investigations, and coordination with providers to ensure compliance. A valid driver’s license is required; experience with Medicaid is preferred.

Qualifications

• Bachelor’s degree or equivalent in a related field; professional experience may substitute for education.
• Experience in human/social services or health care agency settings handling planning, evaluation or program policies.
• Preferred knowledge of Nebraska Medicaid providers and the electronic visit verification system.

Responsibilities

• Gather information from regulations and waivers to help develop internal policies and procedures.
• Conduct data mining and intervention strategies for provider investigations.
• Assist with investigations and communications with providers.
• Ensure HCBS providers use the electronic visit verification system.
• Plan, monitor and evaluate program activities for day-to-day operations of the Program Integrity Team.
• Review federal/state regulations to shape policies and interpretations for the team.
• Draft and implement policy and program regulations with uniform guidelines.
• Research and report on regulations that affect assigned programs for policy changes.

Education

Bachelor’s degree or equivalent coursework in public administration, social/behavioral sciences, healthcare, human services or related field

Job description

Nebraska Department of Health and Human Services in Lincoln, NE seeks a Program Integrity Specialist for Medicaid and Long-Term Care to lead program integrity efforts. The role focuses on expert knowledge of regulations, HCBS requirements, and ensuring use of the electronic visit verification system.

Responsibilities include policy development, investigations, and coordination with providers to ensure compliance. A valid driver’s license is required; experience with Medicaid is preferred.