Healthcare Audit & Investigations Manager

AHCCCS

Phoenix (AZ)

Hybrid

USD 110,000 - 150,000

Full time

4 days ago

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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.