Audit Manager

Ahcccs; Phoenix (AZ); Hybrid; USD 110,000 - 150,000; Full time

Job summary

AHCCCS in Phoenix seeks an Audit Manager reporting to the Inspector General to lead the Quality Assurance Nurse Investigations Unit. The role blends clinical expertise with complex healthcare fraud and mismanagement investigations, emphasizing regulatory compliance and strategic leadership.

You will supervise staff, conduct clinical and financial reviews, prepare investigative interviews and testimony, and collaborate with executive leadership on org-wide initiatives to strengthen program

Qualifications

• Active RN license in Arizona with current status.
• 5+ years in hospital settings; 3+ years in investigative or audit roles.
• Strong knowledge of utilization review and case management.
• Experience with clinical record review, healthcare data analysis, and investigative techniques.
• Proven leadership, supervision, and staff development abilities.
• Advanced data analysis and medical necessity evaluation skills.

Responsibilities

• Lead the Quality Assurance Nurse Investigations Unit under AHCCCS OIG.
• Conduct complex medical and financial investigations related to healthcare fraud and program mismanagement.
• Provide staff leadership, conduct clinical case reviews, and prepare testimony.
• Collaborate with executive leadership on strategic initiatives and regulatory compliance.

Skills

Utilization Review

Case Management

Data analysis

Investigative techniques

Leadership

Staff development

Clinical record review

Medical necessity

Education

Arizona RN License

Job description

The Audit Manager reports to the Inspector General within Arizona's Health Care Cost Containment System (AHCCCS) Office of Inspector General and oversees the Quality Assurance Nurse Investigations Unit. This highly skilled registered nurse with utilization review experience provides leadership to staff, conducts complex medical and financial investigations related to healthcare fraud and program mismanagement, and ensures compliance with regulatory standards. The role involves clinical case review, investigative interviews, testimony preparation, and collaboration with executive leadership on strategic initiatives.

Key qualifications:

• Arizona RN License or higher from Arizona Nursing Board
• Five or more years in a hospital setting; three or more years of investigative or audit experience
• Knowledge of Utilization Review and Case Management
• Clinical record review, healthcare data analysis, and investigative techniques
• Leadership, supervision, and staff development capabilities
• Advanced data analysis and medical necessity evaluation skills