Remote Medicaid Program Integrity Lead, Behavioral Health

State of Minnesota; Saint Paul (MN); Hybrid; USD 72,000 - 105,000; Full time

Job summary

The State of Minnesota seeks a Medicaid Program Integrity Review Supervisor to lead the Behavioral Health Administration’s payment integrity efforts, oversee a five-person team, and coordinate CMS focused reviews. This role requires clinical and policy review expertise and strong leadership within a statewide Medicaid context.

You will drive program expansion, ensure compliance with data practices, and advise leadership on policy changes to close program vulnerabilities.

Qualifications

• Demonstrated leadership experience in supervisory roles.
• Three (3) years of advanced-level work experience conducting clinical and policy reviews of Medicaid services.
• In-depth knowledge of Minnesota's behavioral health service delivery system and Medicaid rules.
• Hands-on experience with program integrity review methods including prepayment and focused reviews.

Responsibilities

• Direct BHA's Medicaid payment integrity review program across SUD, mental health, and integrated services, setting goals and strategy.
• Exercise supervisory authority to ensure labor agreements are administered and staff duties are met to achieve unit objectives.
• Lead planning and expansion of Medicaid program integrity review across BHA and shape policy and legislative framework.
• Serve as BHA's operational lead for CMS focused review activity and liaise with DHS, CMS and external partners.
• Direct unit quality assurance, review targeting, and performance measurement with the data analytics team.
• Ensure program records, appeals support, and data handling meet audit and data practices requirements.

Skills

Leadership experience

Supervisory experience

Policy review experience

Clinical review experience

Data analytics awareness

Education

Bachelor’s degree in healthcare administration, social work, mental health, or related field

Master’s degree may substitute for two years of experience

Job description

The State of Minnesota seeks a Medicaid Program Integrity Review Supervisor to lead the Behavioral Health Administration’s payment integrity efforts, oversee a five-person team, and coordinate CMS focused reviews. This role requires clinical and policy review expertise and strong leadership within a statewide Medicaid context.

You will drive program expansion, ensure compliance with data practices, and advise leadership on policy changes to close program vulnerabilities.