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.
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
Current licensure as a Registered Nurse, Nurse Practitioner, or Physician Assistant in good standing with the applicable licensing board
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:
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
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.
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.
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. If you have questions about applying for jobs, contact the job information line at .
For additional information about the application process, go to
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
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
Work Shift:* Day
Work Hours:* 8:00am
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
State Of Minnesota