Audit Manager
About The Position
The Audit Manager works in the Office of Inspector General (OIG) at the Arizona Health Care Cost Containment System (AHCCCS) and reports to the Inspector General. This role provides direct oversight of the Quality Assurance Nurse Investigations Unit and requires advanced registered nursing and utilization review expertise. The manager guides staff and executive management and supports the Inspector General’s administrative and management work, projects, initiatives, data analytics, and investigations involving healthcare fraud and program mismanagement. The position leads unit operations and staff development, provides clinical guidance on complex medical investigations, and ensures work meets OIG standards and applicable regulations. It also coordinates internal and external reviews, contributes to OIG strategic planning, reviews investigative reports and case assessments, and performs complex clinical, financial, and data analysis. The manager negotiates and finalizes overpayment, civil monetary penalty, settlement, and forfeiture determinations with required approvals; participates in appeals and settlement conferences; and may conduct interviews and provide testimony. Travel for state business may be required. The job is based at 150 North 18th Avenue, Phoenix, Arizona, and AHCCCS employees must reside in Arizona. Remote work may be available at management’s discretion.
Requirements
- Arizona driver license.
- RN license or higher from the Arizona Board of Nursing, as specified in the posting.
- Professional education and training in medical care or appropriate medical practice, demonstrated by a qualifying medical license, certificate, or degree, as described in the cited federal regulation.
- Successfully pass a fingerprint background check, prior employment verifications, and reference checks.
- Complete required driver training if driving on state business.
Nice To Haves
- Five or more years of experience in a hospital setting.
- Three or more years of investigative or audit experience.
- Knowledge of Utilization Review and Case Management.
- Experience as a team lead or supervisor.
Responsibilities
- Lead and oversee the Quality Assurance Nurse Investigations Unit, including recruiting, developing, and managing staff performance, and ensure operations comply with OIG standards, policies, and procedures.
- Apply advanced clinical expertise to guide detailed and complex medical investigations and ensure accuracy, quality, and regulatory compliance.
- Liaise with the Inspector General, Deputy Assistant Directors, Deputy Inspectors General, and internal stakeholders on projects and strategic initiatives.
- Coordinate responses to external audits, reviews, and interrogatories, ensuring accuracy and timeliness.
- Contribute to development and implementation of OIG strategic plans, annual goals, and objectives.
- Interpret and apply complex medical, financial, and operational AHCCCS regulations and applicable federal and state laws to inform decisions and investigative outcomes.
- Conduct final reviews and approve investigation reports, case closures, and clinical case assessments; verify evidence is documented and supports findings and conclusions.
- Tailor documentation and communications for internal leadership and external regulatory audiences, complying with reporting standards.
- Perform complex clinical, financial, and data analysis and document findings to support defensible outcomes and regulatory accountability.
- Negotiate and finalize determinations involving overpayments, civil monetary penalties, settlements, and forfeitures, obtaining required Inspector General approvals and authorizations.
- Participate in administrative appeals and Informal Settlement Conference processes, representing OIG interests.
- Conduct investigative interviews and provide expert, fact, and summary testimony in legal and administrative proceedings as required.
- Mentor, develop, and train staff, fostering a competent and high-performing workforce.
- Align planning with the OIG strategic plan, mission, and Agency Management System; guide staff participation in modernization and organizational change initiatives.
- Coordinate internal and external liaisons.
Benefits
- 10 paid holidays per year.
- Paid vacation and sick leave (13 and 12 days per year, respectively), accruing from the first day of employment; prorated for part-time employees.
- Paid parental leave of up to 12 weeks per year for a newborn or newly placed foster or adopted child.
- Bereavement, civic duty, and military leave.
- Retirement program with lifetime pension benefits through the Arizona State Retirement System.
- Medical, dental, life, and disability insurance.
- Eligibility to participate in the Public Service Loan Forgiveness Program, subject to qualifications.
- RideShare and public transit subsidy.
- Learning and career development opportunities.
- Remote work schedule option, subject to management approval and discretion.
- Voluntary deferred retirement compensation program through Nationwide.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
Associate degree
