Program Integrity Coordinator, Managed Care Organizations; MCOs​/Human Services Program Repre

Program Integrity Coordinator, Managed Care Organizations (MCOs) / Human Services Program Representative 2

Working Title: Program Integrity Coordinator, Managed Care Organizations (MCOs)

Job Class: Human Services Program Representative 2

Agency: Human Services Dept

• Job
• Location:
  
  St. Paul
• Telework Eligible:
  Yes
• Full/Part Time:
  Full-Time
• Regular/Temporary:
  Limited
• Who May Apply:
  Open to all qualified job seekers
• Date Posted: 01/09/2026
• Closing Date: 01/22/2026
• Hiring Agency/Seniority Unit:
  Human Services Dept / MAPE DHS Central Office
• Division/Unit:
  Department of Human Services (DHS) / Office of Inspector General (OIG)-PIO POAI MCO Unit
• Work Shift/
  
  Work Hours:
  
  Day Shift / 8:00 a.m.
  
  - 4:30 p.m.
• Days of Work:
  Monday - Friday
• Travel Required:
  
  Yes
• Salary Range: $32.40 - $47.76 / hourly; $67,651 - $99,722 / annually
• Classified Status:
  Unclassified
• Bargaining Unit/Union: 214 - MN Assoc of Professional Empl/MAPE
• End Date: 01/01/2028
• FLSA Status:
  Nonexempt

The Department of Human Services (DHS) is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify.

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.

• Approximately 10% travel.
• This position is eligible for telework for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework.

Minnesota’s contracted Managed Care Organizations (MCOs) are required by federal rule and as a condition of contracting with the State of Minnesota to conduct a variety of program integrity activities and establish Special Investigations Units (SIUs) that conduct specific activities designed to prevent, detect, and respond to fraud, waste, abuse, and noncompliance with certain contractual or other regulatory requirements that results in improper payments.

In turn, the State of Minnesota, through its Office of Inspector General, is required to ensure that MCOs implement and maintain effective integrity programs designed to detect and prevent fraud, waste, and abuse in the Medical Assistance (MA) program.

This position is responsible for proposing, designing, developing, and coordinating critical program integrity, compliance and anti‑fraud initiatives across the MCOs and between the Fee‑For‑Service (FFS) program. This includes multiple program activities designed to improve compliance, accountability and return on investment.

• Three (3) years of experience in Medicaid program integrity, health care compliance, audits, investigations, or fraud, waste, and abuse (FWA) activities.
• Knowledge of Minnesota Health Care Programs (MHCP) or other Medicaid programs, including managed care and/or fee‑for‑service delivery systems.
• Experience analyzing program integrity, compliance, audit, or investigative data and applying relevant laws, policies, and contractual requirements.
• Interpret and apply federal and state laws, regulations, and policies related to Medicaid or other publicly funded health care programs.
• Experience coordinating work with multiple internal and external stakeholders.
• Proficiency in Microsoft Word and Excel, including the ability to prepare reports, documentation, and summaries.

• Experience working with Managed Care Organizations (MCOs), including oversight of contractual program integrity or Special Investigation Unit (SIU) activities.
• Experience with Medicaid fraud referrals, concurrent investigations, or coordination with entities such as MFCU, AGO, CMS, or law enforcement partners.
• Advanced knowledge of Medicaid program integrity laws and regulations, including credible allegation of fraud standards and sanction processes.
• Experie…