Lead Restricted Recipient Senior Investigator - Saint Paul, United States - State of Minnesota

    State of Minnesota
    State of Minnesota Saint Paul, United States

    4 weeks ago

    Default job background
    Description

    Working Title:
    Lead Restricted Recipient Senior Investigator

    Job Class:
    Human Services Program Consultant

    Agency:
    Human Services Dept


    • Job ID : 76409

    • 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 : 05/02/2024

    • Closing Date : 05/08/2024

    • Hiring Agency/Seniority Unit :
    Human Services Dept / MAPE DHS Central Office



    • Division/Unit :
    Department of Human Services (DHS) / Office of Inspector General (OIG) Restricted Recipient Prg



    • Work Shift/Work Hours :
    Day Shift / 8:00 a.m. - 4:30 p.m.



    • Days of Work :
    Monday - Friday



    • Travel Required :
    Yes



    • Salary Range: $ $50.27 / hourly; $70,783 - $104,963 / annually

    • Classified Status :
    Classified



    • Bargaining Unit/Union : 21- MN Assoc of Professional Empl/MAPE

    • FLSA Status :
    Exempt - Administrative


    • Designated in Connect 700 Program for Applicants with Disabilities ) : Yes
    The Department of Human Services is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment.


    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 has a flexible work arrangement that may allow for_ Telework )
    _(within Minnesota or neighboring States) and flexible hours options are available_
    _or a mixture of working in our office and_ Telework )
    _._

    _Approximately 5% travel to meetings._


    _This position exists to direct and coordinate restricted recipient program efforts of the Minnesota Restricted Recipient Program (MRRP) and assist in managing the participants in the Universal Restrict Recipient Program (URRP).

    _

    _Responsibilities include but are not limited to:_

    _

    • _ _Running quarterly meetings for the URRP._
    _

    • _ _Support, develop, and lead URRP efforts._
    _

    • _ _Provide guidance, direction, and management to the URRP from a Restricted recipient program oversight and Office of Inspector General (OIG) perspective._
    _

    • _ _Provide technical consultation on legislative, policy, and compliance issues._
    _

    • _ _Manage writing and presenting of appeals in the Supervisor absence_ and assure the Human Service Judge (HSJ) is provided all necessary information and material to successfully pursue Department of Human Services (DHS') actions.

    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.
    _
    Three (3) years of specialized professional experience directing, managing, and developing activities of Minnesota Restricted Recipient Program (MRRP).


    Experience must demonstrate the following:
    _

    • _ _Registered Nurse (RN) License._
    _

    • _ _Experience working with or for a Managed Care Organization._
    _

    • _ _Analyze claims data, provider documentation, financial records, and other restricted recipient program related data and identify discrepancies._

    · Knowledge of state requirements and procedures sufficient to draft and process contracts.


    Preferred Qualifications
    _

    _ _Knowledge of the following:
    _

    _o_ _Legislation, rule, and managerial approaches to human services programs, with MRRP being prioritized._

    _o_ _Fee-for-service and managed care programs._

    _o_ _Third party liability and benefit recovery principles._

    _o_ _Federal and state goals and objectives related to the implementation of Restricted Recipient Program._

    _o_ _Federal and state laws and rules governing Restricted Recipient Program and other DHS contracted entities._

    _o_ _Medicare program and how it interacts with the Medicaid program._

    _o_ _Medical Assistance, MinnesotaCare, Managed Care Organization, and Consolidated Chemical Dependence Treatment Fund._

    _o_ _Minnesota Medicaid Information System (MMIS) and the Data Warehouse._

    _o_ _Minnesota Medicaid claims processing and coding systems._

    • Develop and maintain a compliance system.
    • Ensure that all work completed meets legal and contractual obligations.
    • Leading and managing the scope of audits.
    _

    • _ _Write clearly and effectively to broad audiences._
    _

    • _ _Speak clearly, confidently, and concisely in both large and small group settings._
    _

    • _ _Effective in managing workload and deadlines._
    _

    • _ _Able to demonstrate strong investigative, analytical, problem solving, and organizational skills with the ability to produce and measure performance and results._
    _

    • _ _Working knowledge of Microsoft Word, Excel, Adobe, and basic computer programs._
    _

    • _ _Knowledge of data and systems used in utilization management and restricted recipient program environments._
    _

    • _ _The ability to format, analyze, and prepare computer generated reports containing narrative and numeric data._
    • Provide education, clarification, and interpretations on MRRP policy to staff.
    _

    • _ _Respond and adapt to changes in priorities, operations, policies, procedures, laws, and rules within a minimal time frame._
    • Variety of experiences working effectively with others from different backgrounds and cultures.

    Additional Requirements


    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.


    REFERENCE/BACKGROUND CHECKS - The Department of Human Services will conduct reference checks to verify job-related credentials and criminal background check prior to appointment.


    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 or email .

    Please indicate what assistance is needed.