RN Audit Manager, Healthcare Investigations (Remote)

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

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.