Remote MCO Program Integrity Consultant

Minnesota Department of Human Services; Saint Paul (MN); Hybrid; USD 69,000 - 101,000; Full time

Job summary

The Minnesota Department of Human Services is seeking a Managed Care Organization (MCO) Program Integrity Consultant to advance program integrity across DHS’s MCOs.

Based in Saint Paul, this full-time unclassified role requires expertise in health care fraud, audit design, and reporting, with telework options and occasional travel. You will collaborate with OIG, PIO, and external partners to strengthen compliance and monitor performance.

Qualifications

• Three (3) years of experience monitoring, auditing and overseeing activities related to program compliance.
• Knowledge of health care fraud, waste and abuse, as well as program integrity and anti-fraud initiatives.
• Assess integrity program effectiveness and recommend solutions.
• Format, analyze, and/or prepare computer generated reports containing narrative and numeric data.

Responsibilities

• Plan, design, develop, conduct, and report on results of focused monitoring and auditing of MCO compliance with program integrity requirements.
• Serve as a technical expert on MCO program integrity requirements and compliance monitoring to advise division leadership and coordinate engagements with MCOs.
• Evaluate and report on MCO compliance with federal rules, Minnesota statute and rules, and DHS policies.
• Serve as a liaison between the OIG, PIO, MCO SIUs and Restricted Recipient Programs, and state/federal partners.

Skills

Health care fraud knowledge

Program integrity

Reporting and analytics

Performance metrics development

Tools

Microsoft Word

Excel

Job description

The Minnesota Department of Human Services is seeking a Managed Care Organization (MCO) Program Integrity Consultant to advance program integrity across DHS’s MCOs.

Based in Saint Paul, this full-time unclassified role requires expertise in health care fraud, audit design, and reporting, with telework options and occasional travel. You will collaborate with OIG, PIO, and external partners to strengthen compliance and monitor performance.