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Senior Investigator, MN Restricted Recipient Program / Human Services Program Representative 2

Company: Minnesota Department of Human Services
Location: saint paul
Posted on: May 3, 2021

Job Description:

Job Class: Human Services Program Representative 2 Working Title: Senior Investigator, MN Restricted Recipient Program Who May Apply: Open to all qualified job seekers Date Posted: 04/07/2021 Closing Date: 04/20/2021 Hiring Agency/Seniority Unit: Human Services Dept / MAPE DHS Central Office Division/Unit: DHS-Central Office / Financial Fraud and Abuse Investigations - Restricted Recipient Program Work Shift/Work Hours: Day Shift / 8:00am - 4:30pm Days of Work: Monday - Friday Travel Required: No Salary Range: $27.56 - $40.61/hourly; $57,545 - $84,793/annually Classified Status: Classified Bargaining Unit/Union: 214 - MN Assoc of Professional Empl/MAPE FLSA Status: Nonexempt Connect 700 Program Eligible : Yes 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 Bachelor's Degree in nursing, human services or closely related field may substitute for 1 year of experience OR Master's degree in nursing, human services or closely related field may substitute for 2 years of experience 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 Strong communication skills in presenting and assessing cases Proficiency in general computer skills including applications such as Microsoft Office, electronic health care records, or other database systems 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 The ability to learn and apply the techniques of health care investigation, including procedures and strategies for detecting patterns of abuse and misuse of medical services 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.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.

Keywords: Minnesota Department of Human Services, St. Paul , Senior Investigator, MN Restricted Recipient Program / Human Services Program Representative 2, Other , saint paul, Minnesota

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