Medicaid Provider Investigations Manager – Community-Based /Human Services Manager 2

Job summary

Lead and manage investigations into community-based providers serving Minnesota public health programs, with a focus on detecting fraud, waste, abuse, and other high-risk patterns. Direct investigative staff, develop investigative practices and protocols, provide subject matter expertise, and coordinate oversight and enforcement with government and program partners.

Job details

Working Title: Medicaid Provider Investigations Manager – Community-Based Job Class: Human Services Manager 2 Agency: Human Services Dept Job ID: 98253 Location: St. Paul Telework Eligible: Yes Full/Part Time: Full-Time Regular/Temporary: Unlimited Who May Apply: Open to all qualified job seekers Date Posted: 11/05/2026 Closing Date: 11/25/2026 Hiring Agency/Seniority Unit: Human Services Dept / DHS Manager Division/Unit: Department of Human Services (DHS) / Office of Inspector General (OIG)-PIO Operations Management Work Shift/Work Hours: Day Shift / 8:00 a.m. - 4:30 p.m. Days of Work: Monday - Friday Travel Required: Yes Salary Range: $44.80 - $64.46 / hourly; $93,542 - $134,592 / annually Classified Status: Classified Bargaining Unit/Union: 220 - Manager/Unrep FLSA Status: Exempt - Executive Designated in Connect 700 Program for Applicants with Disabilities: Yes 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. The work you'll do is more than just a job. 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. 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. Approximately 10% travel. Under general administrative direction of the Deputy Inspector General of the Program Integrity Oversight (PIO) Division, this position is responsible for executive leadership, operational management, strategic planning, and direction of community-based provider investigations within the Office of Inspector General (OIG). The incumbent provides broad investigative oversight for community-based services funded through the Minnesota Department of Human Services (DHS) and the Minnesota Health Care Programs (MHCP) fee-for-service system, including community support, home, residential, behavioral health, transportation, and other community-based services. Responsibilities Include But Are Not Limited To Directs investigations involving a wide range of provider types and service delivery models, with particular attention to emerging fraud, waste, and abuse risks and provider types designated as high risk. Develops and implements investigative practices, procedures, and protocols that support the payment integrity, appropriateness, and legitimacy of community-based services delivered to public program recipients. Directs a team of supervisors, lead investigators, and investigators. Provides subject matter expertise on community-based service delivery models, investigative methodologies, billing and utilization patterns, including emerging and high-risk patterns, and the regulatory frameworks governing community-based providers. Collaborates with federal and state law enforcement, regulatory, and program partners to ensure effective and coordinated program integrity oversight and enforcement across community-based services. All DHS Leaders are expected to demonstrate and develop the five (5) competency themes: Leading Self Leading Others Leading the Organization Leading Outside the Organization Getting Work Done Minimum Qualifications 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.** Demonstrated leadership experience* Leadership experience can include: Experience as a supervisor, lead worker, team lead, project lead; Completion of a State of Minnesota leadership program (e.g. ELI, L4); A paid/unpaid position leading a program or chairing a committee (e.g. ERG) - experience must include: 1+ year of experience identifying issues, goals and strategic actions 100+ hours per year time commitment Five (5) years of providing direction to a work unit responsible for investigatory, compliance, or program integrity activities in community support, home and residential services providers or a comparable setting; and Experience Must Demonstrate The Following Leading, supervising, or coordinating teams. Develop, implement and maintain written investigative protocols for community-based provider types or similar. Develop and maintain working relationships with internal and external partners. Leverage data analytics to identify trends and/or for investigative reporting. Preferred Qualifications Working knowledge of the following: Health care program integrity principles, methods and practices as they apply to community-based, home and residential services providers, including fraud typologies unique to community support settings such as billing for services not rendered, falsified documentation, unauthorized services and exploitation of vulnerable recipients in home settings. Minnesota's community-based, home and residential services delivery systems, payment mechanisms and costs as they relate to high-risk provider types. Legislative processes, documents and procedures sufficient to support the development of program integrity-related legislation and regulatory changes. Reimbursement methodologies and systems used to reimburse community-based and home services providers, including documentation standards and claims billing practices unique to these provider types. The role of county agencies and tribal programs in the delivery and oversight of community-based health and human services, and the intergovernmental relationships relevant to community-based fraud prevention and detection. Develop, implement, evaluate and alter administrative processes, and to plan and implement policy, program, operations and budget changes affecting a complex investigative unit. Strong written and oral communication skills sufficient to produce technical documents, agency policies, legislative reports and systems requests, and to represent the unit effectively to diverse audiences including county agencies, tribal programs and community-based provider organizations. Variety of experiences working effectively with others from different backgrounds and cultures. Additional Requirements This position requires successful completion of the following: It Is The Policy Of The Department Of Human Services That The Individual Selected For This Position Successfully Complete a Background Investigation Prior To Employment, Including The Following Components Criminal background check Reference check Fingerprinting check (MNJIS/CJIS) Complete the Criminal Justice Information System (CJIS) Security Awareness training within 3-business days from the start of employment; and successfully obtain/retain CJIS certification annually. How To Apply Select “Apply for Job” at the top of this page. If you have questions about applying for jobs, contact the Careers Help Desk at 651-259-3637 or email careers@state.mn.us. For additional information about the application process, go to http://www.mn.gov/careers. Contact If you have questions about the position, contact Stephanie Borscheid at Stephanie.A.Borscheid@state.mn.us. To receive consideration as a Connect 700 Program applicant, apply online, email the Job ID#, the Working Title and your valid Proof of Eligibility Certificate by the closing date to Carolyn Rice at carolyn.rice@state.mn.us. 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 DEPARTMENT OF HUMAN SERVICES_ADA@state.mn.us for assistance. About Human Services Dept WE MAKE A DIFFERENCE! The Minnesota Department of Human Services impacts the lives of 1.7 million people every year, helping them meet their basic needs so they can achieve their highest potential. Working together to improve the state we love. What do Minnesota's State employees have in common? A sense of purpose in their work Connection with their coworkers and communities Opportunities for personal and professional growth Benefits As an employee, you'll have access to one of the most affordable health insurance plans in Minnesota, along with other benefits to help you and your family be well. Your Benefits May Include Paid vacation and sick leave 12 paid holidays each year Low-cost medical, dental, vision, and prescription drug plans Fertility care, including IVF Diabetes care Dental and orthodontic care for adults and children 6 weeks paid leave for parents of newborn or newly adopted children Pension plan that provides income when you retire (after working at least three years) Employer paid life insurance to provide support for your family in the event of death Short-term and long-term disability insurance that can provide income if you are unable to work due to illness or injury Tax-free expense accounts for health, dental, and dependent care Resources that provide support and promote physical, emotional, social, and financial well-being Support To Help You Reach Your Career Goals Training, classes, and professional development Tuition reimbursement Federal Public Service Loan Forgiveness Program (Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, visit the Federal Student Aid website at studentaid.gov) Employee Assistance Program (EAP) For Work/life Support A voluntary confidential program that helps employees and their families with life challenges that may impact overall health, personal well-being, or job performance Common sources of stress can be addressed through the EAP: mental health, relationship challenges (personal and work), grief and loss, finances, and legal issues Daily Living/Convenience Services: Chore services, home repair, trip planning, child/elder care Programs, resources and benefits eligibility varies based on type of employment, agency, funding availability, union/collective bargaining agreement, location, and length of service with the State of Minnesota. EQUAL OPPORTUNITY EMPLOYERS Minnesota state agencies are equal opportunity, affirmative action, and veteran-friendly employers. State agencies are committed to creating a workforce that reflects the diversity of the state and strongly encourages persons of color and Indigenous communities, members of the LGBTQIA2S+ community, individuals with disabilities, women, and veterans to apply. The varied experiences and perspectives of employees strengthen the work we do together and our ability to best serve Minnesotans. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, national origin, sex (including pregnancy, childbirth, and disabilities related to pregnancy or childbirth), gender identity, gender expression, marital status, familial status, age, sexual orientation, status regarding public assistance, disability, veteran status or activity in a local Human Rights Commission or any other characteristic protected by law. Applicants With Disabilities Minnesota state agencies make reasonable accommodations to their employees and applicants with disabilities. If you have a disability and need assistance in searching or applying for jobs with the State of Minnesota, call the Careers Help Desk at 651-259-3637 or email careers@state.mn.us and let us know the support you need.

What you’ll do

Lead and manage investigations into community-based providers serving Minnesota public health programs, with a focus on detecting fraud, waste, abuse, and other high-risk patterns. Direct investigative staff, develop investigative practices and protocols, provide subject matter expertise, and coordinate oversight and enforcement with government and program partners.

Requirements

Requires demonstrated leadership experience, at least one year identifying issues and strategic actions with a substantial time commitment, and five years directing a unit responsible for investigations, compliance, or program integrity in community-based services or a comparable setting. Candidates must demonstrate experience leading teams, developing written investigative protocols, maintaining partner relationships, and using data analytics to identify trends or support investigative reporting.

Benefits

• Paid Vacation And Sick Leave
• 12 Paid Holidays
• Medical Insurance
• Dental Insurance
• Vision Insurance
• Prescription Drug Coverage
• Fertility Care
• Paid Parental Leave
• Pension Plan
• Employer-Paid Life Insurance
• Short-Term And Long-Term Disability Insurance
• Health, Dental, And Dependent Care Expense Accounts
• Well-Being Resources
• Training And Professional Development
• Tuition Reimbursement
• Public Service Loan Forgiveness Program
• Employee Assistance Program

Listed skills

• Team Supervision · Preferred
• Regulatory Compliance · Preferred
• Policy development · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Investigative Leadership
• Team Supervision
• Program Integrity
• Fraud Investigation
• Investigative Protocol Development
• Strategic Planning
• Operational Management
• Data Analytics
• Trend Analysis
• Healthcare Claims And Billing
• Community-Based Services
• Regulatory Compliance
• Partner Collaboration
• Policy Development
• Written And Oral Communication
• Risk Assessment

Job areas

• Government & Public Sector
• Management & Leadership
• Healthcare
• Security & Safety
• Data & Analytics

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