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Senior Investigator, Minnesota Restricted Recipient Program / Human

Expired Job

State Of Minnesota Saint Paul , MN 55101

Posted 4 months ago

Job Summary


Job Summary


The Restricted Program Senior Investigator is part of the Surveillance and Integrity Review Section (SIRS), Minnesota Restricted Recipient Program (MRRP) team which is responsible for identifying, reviewing, and investigating inappropriate use of health care services by Minnesota Health Care Program (MHCP) recipients in order to reduce inappropriate expenditures of program funds.

In this position you will review MHCP claims and monitor individual recipient cases to assure appropriate utilization of health care services and continuing program compliance.

Responsibilities include:

  • Review health care and pharmacy claims, and patient medical records, applying knowledge of medical standards and practice, conditions and treatments to identify patterns of abuse of health care services

  • Manage multiple cases; set and adjust work priorities based on management directive and assigned case load

  • Develop and carry out special projects designed to identify program abuse by recipients and providers

  • Assist in the review and development of MRRP procedures, changes in rules, regulations and manuals and in development of methods of reporting to other agencies

  • Prepare and coordinate assigned aspects of appeals by preparing documentation, memos and medical records for appeals, and testify in state fair hearings as necessary

  • Assess the necessity of health care services and pharmaceuticals from a medical standpoint in the context of Minnesota Health Care Programs (MHCP) and applicable federal and state regulations

  • Research the specifics of various conditions in order to determine the appropriateness of care, services and equipment being provided to individuals enrolled in MHCP

  • Apply techniques of health care investigation, including procedures and strategies for detecting patterns of abuse and misuse of medical services

  • Effectively communicate with a variety of audiences including challenging and upset individuals

Qualifications



Minimum Qualifications:


Current licensure as a Registered Nurse, Nurse Practitioner, or Physician Assistant in good standing with the applicable licensing board

AND

Three (3) years of experience working as a Registered Nurse, Nurse Practitioner, or Physician Assistant including experience working with health care policy, programs, and service delivery systems

Experience must demonstrate the following:

  • Understanding of a broad range of acute and chronic illnesses, disabilities and traumatic injuries which require medical intervention and services as well as a thorough understanding of prescription drugs


Preferred Qualifications:

  • Five (5) years clinical experience as an Registered Nurse, Nurse Practitioner or Physician Assistant with experience working with health care policy, programs, and service delivery systems

  • Knowledge of the Minnesota Restricted Recipient Program

  • Experience in conducting investigations

  • Experience testifying at criminal or administrative hearings

  • Understanding of federal and state administrative and statutory requirements pertaining to potential fraud or misuse of medical services

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.

Application Details


Why Work For Us


GREAT BENEFITS PACKAGE

! The State of Minnesota offers a comprehensive benefits package including low cost medical and dental insurance, employer paid life insurance, short and long term disability, pre-tax flexible spending accounts, retirement plan, tax-deferred compensation, generous vacation and sick leave, and 11 paid holidays each year.

Our mission as an employer is to actively recruit, welcome and support a workforce, which is diverse and inclusive of people who are underrepresented in the development of state policies, programs and practices, so that we can support the success and growth of all people who call Minnesota home.


How to Apply


Click Apply at the bottom of this page

. If you have questions about applying for jobs, contact the job information line at .

For additional information about the application process, go to


Contact


If you have questions about the position

, contact Wendy Savakes at .

If you are a Connect 700 applicant, please email your certificate to Joua Aeling at by the position close date.

If you are an individual with a disability and need an ADA accommodation for an interview, you may contact the Department of Human Services ADA Coordinator at or for assistance.


AN EQUAL OPPORTUNITY EMPLOYER

The State of Minnesota is an equal opportunity, affirmative action, and veteran-friendly employer. We are committed to providing culturally responsive services to all Minnesotans. The State of Minnesota recognizes that a diverse workforce is essential and strongly encourages qualified women, minorities, individuals with disabilities, and veterans to apply.

We will make reasonable accommodations 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 you need.

Job Title: Senior Investigator, Minnesota Restricted Recipient Program / Human Services Program Representative 2

Location: St. Paul

  • Job ID:* 26300

Regular/Temporary: Unlimited

  • Full/Part Time:* Full-Time

  • Who May Apply:* Open to all qualified job seekers

  • Date Posted:* 08/29/2018

Closing Date: 09/18/2018

Hiring Agency: Department of Human Services

  • Division/Unit:* Human Services / Office of Inspector General
  • Financial Fraud and Abuse Investigation
  • Work Shift:* Day

  • Work Hours:* 8:00am

  • 4:30pm
  • Days of Work:* Monday
  • Friday
  • Travel Required:* No

  • Salary Range:* $26.30 - $38.75 /hourly; $54,914 - $80,910 /annually

  • Job Class Option:* None

  • Classified Status:* Classified

  • Connect 700 Program Eligible:* Yes

  • Job Class:* Human Services Program Representative 2

Working Title: Senior Investigator, Minnesota Restricted Recipient Program


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If you have questions about applying for jobs, contact the job information line at 651-259-3637. For additional information about the application process, go to http://www.mn.gov/careers. Contact If you have questions about the position, contact Kris Kuhlmann at Kris.H.Kuhlmann@state.mn.us. If you are a Connect 700 applicant, please email your certificate to Joua Aeling at Joua.Aeling@state.mn.us by the position close date. If you are an individual with a disability and need an ADA accommodation for an interview, you may contact the Department of Human Services' ADA Coordinator at 651-431-4945 or DHS_ADA@state.mn.us for assistance. AN EQUAL OPPORTUNITY EMPLOYER The State of Minnesota is an equal opportunity, affirmative action, and veteran-friendly employer. We are committed to providing culturally responsive services to all Minnesotans. The State of Minnesota recognizes that a diverse workforce is essential and strongly encourages qualified women, minorities, individuals with disabilities, and veterans to apply. We will make reasonable accommodations 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 careers@state.mn.us. Please indicate what assistance you need. Return to Previous Page State Of Minnesota Saint Paul MN

Senior Investigator, Minnesota Restricted Recipient Program / Human

Expired Job

State Of Minnesota