Departmental Analyst 12 (Senior MCO Analyst) - Managed Care Oversight Unit - MDHHS OIG
About The Position
This position functions as a Senior Managed Care Oversight Analyst within the Michigan Department of Health and Human Services (MDHHS) Office of Inspector General (OIG). The MDHHS 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 Allegations 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.
Requirements
- Possession of a 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.
- Experience developing and maintaining policy, procedure and guidelines for highly complex functional areas based on broad and nonspecific operational criteria.
Nice To Haves
- Preferred experience in accounting and auditing, managed care, and Medicaid or similar health services program.
Responsibilities
- 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 Allegations of Fraud (CAF), and issues.
- 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.
- 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.
- Conducts annual contract reviews.
Benefits
- Employees will be provided computers to perform state work.
- Phones may also be provided for necessary communications.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
