Audit Manager

Arizona Department of Administration•Phoenix, AZ

About The Position

The Audit Manager in the Office of Inspector General (OIG) reports to the Inspector General and directly oversees the Quality Assurance Nurse Investigations Unit. The position requires a highly skilled Registered Nurse with Utilization Review experience. It provides guidance to staff and executive management and supports the Inspector General on administrative and management issues, projects, initiatives, data analytics, and investigations of healthcare fraud and program mismanagement. The manager leads unit operations and staff, ensures alignment with OIG standards and procedures, and applies advanced clinical expertise to complex medical investigations. The role includes interpreting medical, financial, operational, state, and federal requirements; reviewing investigative reports and evidence; conducting analysis; negotiating and finalizing determinations; participating in appeals and settlement processes; and providing testimony in legal or administrative proceedings. The manager also develops staff, supports strategic planning and organizational modernization, and coordinates internal and external relationships. The position is based at 150 North 18th Avenue, Phoenix, Arizona 85007. AHCCCS employees must reside in Arizona. Travel may be required for State business. Remote work, including a full-time or part-time remote schedule, is available at management's discretion and is not an employee entitlement. Salary is $100,000–$110,000, Grade 25, exempt. The position remains open until filled.

Requirements

Arizona driver license.
RN license or higher from the Arizona Nursing Board, as specified under Arizona Revised Statutes §32-1660.
Professional education and training in medical care or appropriate medical practice, as described in 42 CFR §432.50.
Knowledge of clinical record review and healthcare data analysis.
Knowledge of investigative techniques, interviewing, and evidence evaluation.
Knowledge of regulatory compliance, audit processes, and defensible case development.
Knowledge of Medicaid/Medicare (Title 19), AHCCCS rules, and provider/member eligibility.
Knowledge of federal and Arizona laws, including ARS Titles 13 and 36, and administrative law.
Knowledge of healthcare laws, regulations, and standards.
Knowledge of public assistance program eligibility, including SSI, SSD, TANF, LTC, and SOBRA.
Knowledge of data analysis, spreadsheet development, and AHCCCS/DES system data extraction.
Knowledge of financial and accounting principles used in audits and fraud detection.
Knowledge of organizational leadership, staff development, and performance management.
Knowledge of state personnel rules, EEO, ADA, and workplace compliance.
Skills in leadership, supervision, and staff development.
Skills in clinical review, advanced data analysis, data management, reporting, and Excel.
Skills in investigative documentation and report writing.
Skills in evaluating medical necessity and standards of care.
Skills in process improvement and performance metrics, including LEAN.
Strong communication and collaboration skills.
Ability to provide strategic support and operational oversight, including site visits.
Ability to lead, motivate, and develop high-performing teams; set clear expectations; and align staff across functions.
Ability to exercise sound judgment under pressure, analyze and synthesize complex data, and manage competing priorities.
Ability to apply clinical and investigative methodologies consistently and integrate clinical knowledge into investigative processes.
Ability to build cohesive teams, foster a positive workplace culture, and demonstrate integrity, accountability, and professionalism.
Ability to present findings effectively in formal settings, including testimony, and collaborate with leadership and cross-functional teams.
Ability to align work with organizational mission and strategic goals and apply continuous improvement practices, including LEAN, AMS, and performance metrics.
Successfully pass fingerprint background check, prior employment verifications, and reference checks; employment is contingent on completing these processes and the agency's ability to reasonably accommodate any restrictions.
Complete required driver training if driving on State business, as applicable.
Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), as required for all newly hired State employees.
Reside within the state of Arizona.

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 serving as a team lead or supervisor.

Responsibilities

Lead, direct, and oversee the Quality Assurance Nurse Investigations Unit, including staff recruitment, development, and performance management.
Ensure unit operations comply with OIG standards, policies, and procedures.
Apply advanced clinical expertise to guide complex medical investigations and ensure accuracy, quality, and regulatory compliance.
Liaise with the Inspector General, Deputy Assistant Directors, Deputy Inspectors General, and other internal stakeholders on projects and strategic initiatives.
Coordinate responses to external audits, reviews, and interrogatories, ensuring accuracy and timeliness.
Contribute to OIG strategic plans, annual goals, and objectives.
Interpret and apply complex medical, financial, and operational AHCCCS regulations and applicable federal and state laws to decision-making and investigative outcomes.
Conduct final reviews and approve Reports of Investigation, case closures, and clinical case assessments.
Verify that evidence is consistent, documented, and sufficient to support investigative findings and conclusions.
Tailor documentation and communications for internal leadership and external regulatory entities while meeting reporting standards.
Conduct complex clinical, financial, and data analysis, and document findings to support defensible outcomes and regulatory accountability.
Negotiate and finalize determinations concerning overpayments, civil monetary penalties, settlements, and forfeitures, obtaining required Inspector General approvals.
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 to foster a competent, high-performing workforce.
Align planning with the OIG strategic plan, mission, and Agency Management System (AMS).
Guide staff participation in modernization initiatives and organizational changes, promoting adaptability and continuous improvement.
Coordinate internal and external liaisons.

Benefits

10 paid holidays per year.
Paid vacation and sick time: 13 vacation days and 12 sick days per year, accrued from the first day of employment and 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.
Optional full-time or part-time remote work schedule at management's discretion.
Voluntary Deferred Retirement Compensation Program with tax-deferred payroll investments through Nationwide.
Required participation in the Long-Term Disability and ASRS Retirement plans.