Departmental Analyst ; Senior MCO Analyst - Managed Care Oversight Unit - MDHHS OIG

Job Description

The MDHHS mission is to provide opportunities, services, and programs that promote a healthy, safe, and stable environment for residents to be self-sufficient. We are committed to ensuring a diverse workforce and a work environment whereby all employees are treated with dignity, respect and fairness. For more information, please visit our MDHHS Diversity, Equity, and Inclusion Plan.

This position functions as a Senior Managed Care Oversight Analyst within the Michigan Department of Health and Human Service (MDHHS) Office of Inspector General (OIG). The OIG is a criminal justice agency housed within MDHHS charged with investigating fraud, waste and abuse in programs administered by MDHHS and increasing program integrity and accountability.

The Senior Analyst reviews and investigates the most complex activities and submissions of Medicaid Managed Care Entities (MCEs) and MI Choice Waiver Agencies in relation to fraud, waste, and abuse. Ensures compliance with program integrity requirements through identification and resolution of deficiencies, Credible Allegation of Fraud (CAF), and issues and monitors corrective action plans, sanctions, and penalties of the MCEs including, but not limited to Medicaid Health Plans (MHPs), Prepaid Inpatient Health Plans (PIHPs), Non-Emergency Medical Transportation (NEMT) plan, MI Choice Waiver Agencies, and Dental plans, all of which are responsible for managing certain aspects of health care for Medicaid beneficiaries enrolled in their managed care entities.

The Senior Analyst advises and provides guidance on the interpretation of regulatory changes, develops and updates managed care oversight tools to evaluate, track and monitor program integrity and statewide impact, and conducts annual contract reviews.

• Review and investigate complex Medicaid Managed Care activities and submissions.
• Identify and resolve deficiencies, CAF, and monitor corrective action plans, sanctions, and penalties.
• Provide guidance on regulatory changes and develop managed care oversight tools.
• Conduct annual contract reviews.

• Bachelor's degree in any major.
• Three years of professional experience, including one year of experience equivalent to the experienced (P11) level in state service.
• Preferred experience in accounting and auditing, managed care, and Medicaid or similar health services program.
• Experience developing and maintaining policy, procedure and guidelines for highly complex functional areas based on broad and nonspecific operational criteria.

• Departmental Analyst 9 – 12 educational level typically acquired through completion of high school and the equivalent of at least two years of full-time active-duty experience at or above the E-6 level in the uniformed services may be substituted for the education requirement.

The physical location of this position is 235 S Grand Ave, Lansing, MI 48933. Remote work and hybrid schedules may be considered within established limits. The position must be performed within Michigan.

Successful completion of a background investigation and criminal records check is required. An additional extensive background check will be conducted for candidates being considered.