Medicaid Provider Investigations Manager – Community-Based /Human Services Manager 2

Minnesota Department of Human Services; Saint Paul (MN); Hybrid; USD 94,000 - 135,000; Full time

Benefits offered by this job

Paid vacation and sick leave

12 paid holidays

Pension plan

Life insurance

Disability insurance

Job summary

The Minnesota Department of Human Services (DHS) seeks a Medicaid Provider Investigations Manager - Community-Based in St. Paul.

The role oversees executive leadership and operational management of community-based provider investigations across MHCP-funded services, including home, residential, behavioral health, and transportation. Under the Deputy Inspector General, the incumbent directs a team of investigators, develops protocols, and collaborates with federal/state partners to ensure program

Qualifications

• Five (5) years of providing direction to a work unit responsible for investigatory, compliance, or program integrity activities in community support, home and residential services providers or a comparable setting.
• Leading, supervising, or coordinating teams.
• Develop, implement and maintain written investigative protocols for community-based provider types or similar.
• Develop and maintain working relationships with internal and external partners.
• Leverage data analytics to identify trends and/or for investigative reporting.

Responsibilities

• Directs investigations involving a wide range of provider types and service delivery models.
• Develops and implements investigative practices, procedures, and protocols that support payment integrity and legitimacy of services.
• Directs a team of supervisors, lead investigators, and investigators.
• Provides subject matter expertise on service delivery models, investigative methodologies, and regulatory frameworks.
• Collaborates with federal and state law enforcement, regulatory, and program partners for coordinated oversight.

Skills

Leadership experience

Supervisory experience

Investigations

Data analysis

Job description

• Telework Eligible: Yes

Working Title: Medicaid Provider Investigations Manager - Community-Based

Job Class: Human Services Manager 2

Agency: Human Services Dept

• Job ID: 98253
• 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: 11/05/2026
• Closing Date: 11/25/2026
• Hiring Agency/Seniority Unit: Human Services Dept / DHS Manager
• Division/Unit: Department of Human Services (DHS) / Office of Inspector General (OIG)-PIO Operations Management
• Work Shift/Work Hours: Day Shift / 8:00 a.m. - 4:30 p.m.
• Days of Work: Monday - Friday
• Travel Required: Yes
• Salary Range: $44.80 - $64.46 / hourly; $93,542 - $134,592 / annually
• Classified Status: Classified
• Bargaining Unit/Union: 220 - Manager/Unrep
• FLSA Status: Exempt - Executive
• Designated in Connect 700 Program for Applicants with Disabilities: Yes

The Department of Human Services (DHS) 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.
• Approximately 10% travel.

Under general administrative direction of the Deputy Inspector General of the Program Integrity Oversight (PIO) Division, this position is responsible for executive leadership, operational management, strategic planning, and direction of community-based provider investigations within the Office of Inspector General (OIG). The incumbent provides broad investigative oversight for community-based services funded through the Minnesota Department of Human Services (DHS) and the Minnesota Health Care Programs (MHCP) fee‑for‑service system, including community support, home, residential, behavioral health, transportation, and other community-based services.

Responsibilities include but are not limited to:

• Directs investigations involving a wide range of provider types and service delivery models, with particular attention to emerging fraud, waste, and abuse risks and provider types designated as high risk.
• Develops and implements investigative practices, procedures, and protocols that support the payment integrity, appropriateness, and legitimacy of community-based services delivered to public program recipients.
• Directs a team of supervisors, lead investigators, and investigators.
• Provides subject matter expertise on community-based service delivery models, investigative methodologies, billing and utilization patterns, including emerging and high-risk patterns, and the regulatory frameworks governing community-based providers.
• Collaborates with federal and state law enforcement, regulatory, and program partners to ensure effective and coordinated program integrity oversight and enforcement across community-based services.

All DHS Leaders are expected to demonstrate and develop the five (5) competency themes:

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

Minimum Qualifications

• To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month and year for each job 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 time commitment

Five (5) years of providing direction to a work unit responsible for investigatory, compliance, or program integrity activities in community support, home and residential services providers or a comparable setting; and

• Leading, supervising, or coordinating teams.
• Develop, implement and maintain written investigative protocols for community-based provider types or similar.
• Develop and maintain working relationships with internal and external partners.
• Leverage data analytics to identify trends and\/or for investigative reporting.

Preferred Qualifications

• Working knowledge of the following:
  • Health care program integrity principles, methods and practices as they apply to community-based, home and residential services providers, including fraud typologies unique to community support settings such as billing for services not rendered, falsified documentation, unauthorized services and exploitation of vulnerable recipients in home settings.
  • Minnesota's community-based, home and residential services delivery systems, payment mechanisms and costs as they relate to high-risk provider types.
  • Legislative processes, documents and procedures sufficient to support the development of program integrity-related legislation and regulatory changes.
  • Reimbursement methodologies and systems used to reimburse community-based and home services providers, including documentation standards and claims billing practices unique to these provider types.
  • The role of county agencies and tribal programs in the delivery and oversight of community-based health and human services, and the intergovernmental relationships relevant to community-based fraud prevention and detection.
• Develop, implement, evaluate and alter administrative processes, and to plan and implement policy, program, operations and budget changes affecting a complex investigative unit.
• Strong written and oral communication skills sufficient to produce technical documents, agency policies, legislative reports and systems requests, and to represent the unit effectively to diverse audiences including county agencies, tribal programs and community-based provider organizations.
• Variety of experiences working effectively with others from different backgrounds and cultures.

Additional Requirements

This position requires successful completion of the following:

It is the policy of the Department of Human Services that the individual selected for this position successfully complete a background investigation prior to employment, including the following components:

• Criminal background check
• Reference check
• Fingerprinting check (MNJIS/CJIS)

Complete the Criminal Justice Information System (CJIS) Security Awareness training within 3-business days from the start of employment; and successfully obtain/retain CJIS certification annually.

Contact

If you have questions about the position, contact Stephanie Borscheid at [e-mail].

To receive consideration as a Connect 700 Program applicant, apply online, email the Job ID#, the Working Title and your valid Proof of Eligibility Certificate by the closing date to Carolyn Rice at [e-mail].

If you are an individual with a disability and need an ADA accommodation for an interview, you may contact the Department of Human Services’ ADA Coordinator at 651-431-4945 or DEPARTMENT OF HUMAN [e-mail] for assistance.

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

based on type of employment, agency, funding availability, union/collective bargaining agreement, location, and length of service with the State of Minnesota.

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.