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

State of Minnesota; Saint Paul (MN); Ibrido; USD 94.000 - 135.000; Tempo pieno

Descrizione del lavoro

The State of Minnesota seeks a Medicaid Provider Investigations Manager – Community-Based to lead investigations across community-based services funded by DHS and MHCP. The role requires executive leadership, strategic planning, and management of an inspector general unit, ensuring program integrity in home and community settings.

Telework is eligible for residents with approval; periodic travel is expected.

Competenze

• Five years directing investigative or program integrity activities.
• Experience leading teams and supervising staff.
• Ability to build internal/external partnerships and use data for investigations.
• Knowledge of community-based services and regulatory frameworks.

Mansioni

• Direct investigations involving a wide range of provider types and service delivery models; focus on high-risk patterns.
• Develop and implement investigative practices and protocols for payment integrity and program compliance.
• Direct a team of supervisors, lead investigators, and investigators.
• Collaborate with federal/state partners to ensure coordinated program integrity oversight.

Conoscenze

Leadership

Investigations

Data analytics

Stakeholder collaboration

Strumenti

CJIS Security

Descrizione del lavoro

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 (https://mn.gov/mmb/careers/diverse-workforce/people-with-disabilities/connect700/) : 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 (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.

*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

Experience must demonstrate the following:

• 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.

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.