Program Integrity Specialist-Medicaid and 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

Job Posting

JR2026-00030130 Program Integrity Specialist-Medicaid and Long-Term Care (Open)

The work we do matters!

Health & Human Services - Agency 25

Location:

Lincoln, NE

Hiring Rate

$24.862

Applications No Longer Accepted On

(If no date is displayed, job is posted as open until closed):

Job Description

DHHS is seeking a dedicated human services professional to support and ensure Medicaid and Long-Term Care program integrity for the State of Nebraska.

The Program Integrity Specialist supports the work of the Nebraska Medicaid Program Integrity team by becoming the subject matter expert on program regulations and setting expectations for Home and Community Based Services (HCBS) providers, especially those required to use the electronic visit verification system.

Home and community-based services are available to those who qualify for Medicaid waivers, such as the elderly, adults and children with disabilities, and infants and toddlers with special needs.

This is just one of the ways DHHS helps Nebraskans Live Better Lives.

Job Duties

• Gather information from regulations, waivers, and Department staff to assist with development of internal policy and procedures.
• Conduct data mining, and intervention strategies to use during provider investigations.
• Assist with investigations and correspondence with providers.
• Ensure HCBS providers are using the electronic visit verification system.
• Perform program planning, implementation, monitoring and evaluation of program activities to manage the day-to-day operational and technical functions of the Program Integrity Team.
• Research, review, analyze, and interpret federal regulations, federal laws, state laws and their administrative requirements to formulate appropriate policies, procedures and interpretations for the Program Integrity Team.
• Draft, develop, and implement policy, procedure and program regulations related to assigned program(s) and ensure staff and service provider are working with uniform guidelines by evaluating and coordinating program policies and regulations.
• Research, review, analyze, and report on federal regulations, state laws and administrative requirements that may affect an assigned program for intent and meaning and to formulate appropriate changes in State policies and procedures.
• Write reports, position papers, impact statements and other documents to formulate policy material to cover specific areas of health and human services programs by conducting research and meeting with other department staff, representatives of other agencies and health and/or human service providers.
• Explain, clarify and interpret operational practices, policies, procedures, federal and state regulations, contract requirements and activities related to assigned programs to Program integrity teammates and providers.
• Develop the necessary resources and administrative support to ensure the Nebraska Medicaid Program Integrity Team operates effectively and efficiently by coordinating with other departmental divisions or outside agencies.

Requirements / Qualifications

Minimum Qualifications:

Bachelor’s degree, or equivalent coursework/training, in public administration, social/behavioral sciences, healthcare, human services or other program related field. Professional experience working in a human/social service or health care agency with responsibility for planning or evaluation services, programs or operational policies and practices may substitute in lieu of the educational requirement.

Preferred Qualifications:

Experience with Nebraska Medicaid providers, Medicaid Waiver Services, and the electronic visit verification system. Knowledge of Medicaid federal regulation.

Other:

Valid Driver’s License

Benefits

We offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation.

Check out all that the State of Nebraska has to offer! Benefit eligibility may vary by position, agency and employment status. For more information on benefits, please visit: https://statejobs.nebraska.gov/index.html#benefits

Equal Opportunity Statement

The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity, inclusion, and belonging. We recruit, hire, train, and promote in all job classifications and at all levels without regard to race, color, religion, sex. age, national origin, disability, marital status or genetics.