Audit Manager

Jobgether; Oregon; Hybrid; USD 100,000 - 110,000; Full time

Benefits offered by this job

Remote work options

Paid holidays

Paid vacation

Paid sick leave

Health insurance

Pension plan

Educational training

Job summary

Jobgether seeks an Audit Manager to lead a Quality Assurance Nurse Investigations Unit, guiding complex clinical investigations and ensuring regulatory compliance within public health programs.

The role combines clinical expertise with data analysis, strategic planning, and cross-functional collaboration to support integrity and accountability. Remote-ready with Arizona residency required for some activities.

Qualifications

• Active Registered Nurse (RN) license.
• Arizona driver license.
• Strong knowledge of clinical record reviews, healthcare data analysis, medical necessity, and standards-of-care evaluation.
• Understanding of investigative techniques, interviewing, evidence assessment, audit processes, and defensible case development.
• Knowledge of Medicaid and Medicare regulations, including Title 19, AHCCCS rules, and provider and member eligibility requirements.

Responsibilities

• Lead, direct, and oversee the Quality Assurance Nurse Investigations Unit, including recruitment, staff development, supervision, and performance management.
• Ensure unit operations comply with established standards and objectives.
• Guide complex medical investigations with accuracy, quality, and regulatory compliance.
• Serve as liaison with the Inspector General and other stakeholders on strategic initiatives.
• Coordinate responses to external audits, reviews, and formal inquiries.
• Develop and implement strategic plans, annual goals, and operational objectives.
• Interpret and apply complex clinical, financial, and regulatory regulations to support decisions.
• Review and approve investigation reports, case closures, and assessments.
• Conduct complex clinical, financial, and data analysis to support defensible outcomes.
• Negotiate determinations involving overpayments, settlements, and penalties.
• Mentor staff and promote a high-performing team culture.
• Align activities with organizational strategy and system.
• Coordinate relationships and site visits as needed.

Skills

RN license

Clinical record reviews

Data analysis

Leadership

Communication

Regulatory compliance

LEAN / process improvement

Interviewing

Arizona driver license

Microsoft Excel

Tools

Microsoft Excel

Job description

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Audit Manager based in the United States.

This leadership opportunity is designed for an experienced Registered Nurse with a strong background in utilization review, clinical investigations, and healthcare auditing. You will oversee a Quality Assurance Nurse Investigations Unit, guiding complex investigations into potential healthcare fraud, program mismanagement, and regulatory non-compliance. Working closely with executive leadership and cross-functional stakeholders, you will help ensure investigative findings are accurate, well-documented, and defensible. The role combines advanced clinical judgment, data analysis, operational oversight, and team development. You will also contribute to strategic initiatives, process improvements, and decisions that support the integrity and accountability of public healthcare programs.

This is a remote-eligible position requiring candidates to reside in Arizona.

Accountabilities

As Audit Manager, you will provide strategic and operational leadership for the nurse investigations function, ensuring high-quality clinical reviews, consistent investigative standards, and effective team performance. Your responsibilities will include:

• Lead, direct, and oversee the Quality Assurance Nurse Investigations Unit, including recruitment, staff development, supervision, and performance management.
• Ensure unit operations comply with established Office of Inspector General standards, policies, procedures, and strategic objectives.
• Apply advanced clinical expertise to guide complex medical investigations, ensuring accuracy, quality, and regulatory compliance.
• Serve as a key liaison with the Inspector General, Deputy Assistant Directors, Deputy Inspectors General, and other internal stakeholders on strategic initiatives and special projects.
• Coordinate responses to external audits, reviews, and formal inquiries, ensuring that information is accurate and delivered on time.
• Contribute to the development and implementation of strategic plans, annual goals, and operational objectives.
• Interpret and apply complex clinical, financial, and operational regulations, as well as applicable federal and Arizona laws, to support investigative decisions.
• Review and approve investigation reports, case closures, and clinical assessments, ensuring that evidence is complete, consistent, and sufficient to support conclusions.
• Conduct complex clinical, financial, and data analysis, documenting findings to support defensible investigative outcomes and regulatory accountability.
• Negotiate and finalize determinations involving overpayments, civil monetary penalties, settlements, and forfeitures, obtaining the necessary approvals.
• Participate in administrative appeals and Informal Settlement Conferences, representing investigative interests.
• Conduct investigative interviews and provide expert, factual, or summary testimony in legal and administrative proceedings when required.
• Mentor and train staff, promote a high-performing team culture, and support organizational modernization and continuous improvement initiatives.
• Align team activities with the organization's strategic plan, mission, and Agency Management System.
• Coordinate internal and external relationships and support operational activities, including site visits when necessary.

Requirements

The successful candidate will combine professional nursing expertise with investigative, analytical, and management capabilities. The position requires:

• An active Registered Nurse (RN) license, or higher, issued by the Arizona State Board of Nursing, in accordance with applicable state and federal requirements.
• An Arizona driver's license.
• Strong knowledge of clinical record reviews, healthcare data analysis, medical necessity, and standards-of-care evaluation.
• Understanding of investigative techniques, interviewing, evidence assessment, audit processes, and defensible case development.
• Knowledge of Medicaid and Medicare regulations, including Title 19, AHCCCS rules, and provider and member eligibility requirements.
• Familiarity with applicable federal and Arizona laws, including Arizona Revised Statutes Titles 13 and 36, as well as administrative law and healthcare regulations.
• Knowledge of public assistance program eligibility, including SSI, SSD, TANF, Long-Term Care, and SOBRA.
• Understanding of financial and accounting principles relevant to audits and fraud detection.
• Experience with data analysis, spreadsheet development, system data extraction, reporting, and Microsoft Excel.
• Strong leadership, supervision, staff development, and performance management skills.
• Excellent investigative documentation, report-writing, communication, and collaboration abilities.
• Ability to interpret complex information, exercise sound judgment under pressure, manage competing priorities, and present findings effectively in formal settings.
• Familiarity with process improvement methodologies, including LEAN, performance metrics, and organizational management systems.
• Ability to build cohesive teams, establish clear expectations, and foster a culture of integrity, accountability, and continuous improvement.

Preferred qualifications

• Five or more years of experience in a hospital setting.
• At least three years of investigative or audit experience.
• Knowledge of Utilization Review and Case Management.
• Previous experience as a team lead or supervisor.

Additional employment conditions

• Candidates must reside within the state of Arizona.
• Successful completion of a fingerprint background check, prior employment verification, and reference checks is required.
• Newly hired employees must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).
• Travel may be required for state business. Employees who drive for work must complete any required driver training and meet applicable licensing requirements.
• Employment is contingent upon successful completion of pre-employment requirements and the ability to reasonably accommodate any restrictions.

Benefits

• Annual salary: $100,000–$110,000.
• Remote work options, with full-time or part-time remote schedules subject to management approval and operational needs.
• 10 paid holidays per year.
• Paid vacation, starting at 13 days annually.
• Paid sick leave, starting at 12 days annually.
• Up to 12 weeks of paid parental leave for eligible employees following the birth or placement of a child through adoption or foster care.
• Additional leave options for bereavement, civic duties, and military service.
• Comprehensive and affordable insurance coverage, including medical, dental, life, and disability insurance.
• Participation in the Arizona State Retirement System, providing a defined-benefit lifetime pension.
• Required participation in the applicable retirement and long-term disability programs.
• Optional deferred compensation program with tax-deferred retirement investments through payroll deductions.
• Eligibility for the Public Service Loan Forgiveness Program, subject to program requirements.
• Rideshare and public transportation subsidies.
• Learning, training, and career development opportunities.