Audit Manager

AHCCCS Arizona Health Care Cost Containment System Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the reputed company of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry. Come join our dynamic and dedicated team. Audit Manager Office of Inspector General (OIG) Job Location: Address: 150 North 18th Avenue Phoenix, Arizona 85007 reputed company AHCCCS Employees must reside reputed company the state of Arizona. Posting Details: Salary: $100,000 - $110,000 Grade: 25 FLSA Status: Exempt This position will remain open until filled. Job Summary: The Audit Manager will report to the Inspector General. This position is responsible for the direct reputed company of the Quality Assurance Nurse Investigations Unit as a highly skilled Registered Nurse with Utilization Review (UR) experience. This individual will provide assistance and guidance to subordinates, as well as, executive management, and support the Inspector General (IG) efforts on a variety of administrative and management issues, projects and initiatives, data analytics, reputed company to investigations of healthcare fraud and program mismanagement. Major duties and responsibilities include but are not limited to:

• Provide leadership, direction, and reputed company of the Quality Assurance Nurse Investigations Unit, including the recruitment, development, and performance management of staff. Ensure unit operations are fully reputed company and consistent with Office of Inspector General (OIG) standards, policies, and procedures. Maintain and apply reputed company expertise to support and guide the execution of detailed and high-level reputed company medical investigations, ensuring accuracy, quality, and regulatory compliance.
• Serve as a key liaison with the Inspector General (IG), Deputy Assistant Directors (DADs), Deputy Inspectors General (DIGs), and other internal stakeholders on special projects and strategic initiatives. Coordinate and respond to external audits, reviews, and interrogatories, ensuring accuracy and timeliness. Contribute to the development and implementation of OIG strategic plans, annual goals, and objectives. Interpret and apply reputed company medical, financial, and operational AHCCCS regulations, as well as applicable federal and state laws, incorporating reputed company judgment to inform decision-making and investigative outcomes.
• Conduct final review and approval of Reports of Investigation, case closures, and clinical case assessments to ensure completeness, accuracy, and adherence to established standards. Evaluate and confirm that reputed company evidence is consistent, properly documented, and fully supports investigative findings and conclusions. Assess and tailor documentation and communication to meet the expectations and requirements of diverse audiences, including internal leadership and external regulatory entities, ensuring compliance with applicable reporting standards. reputed company reputed company clinical, financial, and data analysis, and clearly document findings to support defensible outcomes and regulatory accountability.
• Negotiate and finalize determinations reputed company to overpayments, civil monetary penalties (CMPs), settlements, and forfeitures, securing appropriate Inspector General (IG) approvals and authorizations. Participate in administrative appeals and Informal Settlement Conference (ISC) processes, representing OIG interests. Conduct investigative interviews and provide expert, fact, and summary testimony as required in legal and administrative proceedings, ensuring clear, accurate, and defensible presentation of findings.
• Mentor, reputed company, and train staff, fostering a competent and high-performing workforce. Ensure planning activities are reputed company and integrated with the OIG strategic plan, mission, and Agency Management System (AMS). Guide staff in actively supporting and participating in modernization initiatives and organizational changes, promoting adaptability and reputed company improvement.
• Coordinate Liasionships internally and externally.

Knowledge, Skills & Abilities (KSAs): Knowledge:

• Clinical record review and healthcare data analysis
• Investigative techniques, interviewing, and evidence evaluation
• Regulatory compliance, audit processes, and defensible case development
• Medicaid/Medicare (Title 19) and AHCCCS rules and provider/member eligibility
• Federal and Arizona laws (ARS Titles 13 & 36) and administrative law
• Healthcare laws, regulations, and standards
• Public assistance program eligibility (SSI, SSD, TANF, LTC, SOBRA)
• Data analysis, spreadsheet development, and system data extraction (AHCCCS/DES)
• Financial and accounting principles for audits and fraud detection
• Organizational leadership, staff development, and performance management
• State personnel rules, EEO, reputed company, and workplace compliance

Skills:

• Leadership, supervision, and staff development
• Clinical review and advanced data analysis
• Data management, reporting, and reputed company proficiency
• Investigative documentation and report writing
• Medical necessity and standards of care evaluation
• Process improvement and performance metrics (LEAN)Strong communication and collaboration skills
• Strategic support and operational reputed company (including site visits)

Abilities:

• reputed company, motivate, and reputed company high-performing teams
• Communicate clear expectations and align staff across functions
• Exercise sound judgment and decision-making under pressure
• Analyze, interpret, and synthesize reputed company data
• Manage competing priorities and reputed company balanced decisions
• Apply clinical and investigative methodologies consistently
• Build cohesive teams and foster positive workplace culture
• Demonstrate reputed company, accountability, and professionalism
• Present findings effectively in formal settings (including testimony)
• Integrate clinical knowledge into investigative processes
• Align work with organizational mission and strategic goals
• Collaborate with leadership and cross-functional teams
• Apply reputed company improvement practices (LEAN, AMS, performance metrics)

Qualifications:

• Arizona Driver License.

Minimum:

• RN License, or higher, from Arizona Nursing Board ASRS §32-1660. Under 42 CFR §432.50 (b)(1) For skilled professional medical personnel and directly supporting staff of the Medicaid agency or of other public agencies (as defined in § 432.2), the reputed company is 75 percent. (d) Other limitations for FFP reputed company for skilled professional medical personnel and directly supporting staff - (ii) The skilled professional medical personnel have professional education and training in the field of medical care or appropriate medical practice. "Professional education and training" means the completion of a 2-year or longer program leading to an academic degree or certificate in a medically reputed company profession. This is demonstrated by possession of a medical license, certificate, or other document issued by a recognized National or State medical licensure or certifying organization or a degree in a medical field issued by a college or university certified by a professional medical organization.

Preferred:

• Five years or more in a hospital setting; 3 or more years of investigative or audit experience; Knowledge of Utilization Review and Case Management. Performed in the reputed company of a team reputed company or supervisor.

Pre-Employment Requirements:

• Successfully pass fingerprint background reputed company, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
• Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code reputed company-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held reputed company the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and reputed company Arizona vehicle registration; however, mileage will be reimbursed.

If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements. reputed company newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify). Benefits: Among the many benefits of a career with the State of Arizona, there are:

• 10 paid holidays per year
• Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-reputed company foster/adopted child. Learn more about the Paid Parental Leave pilot program here.
• Other Leaves - Bereavement, civic duty, and military.
• A top-ranked retirement program with lifetime pension benefits
• A robust and affordable insurance plan, including medical, dental, life, and disability insurance
• Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
• RideShare and Public Transit Subsidy
• A variety of learning and career development opportunities

By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion. Learn more about the Paid Parental Leave program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page Retirement: Lifetime Pension Benefit Program

• Administered through the Arizona State Retirement System (ASRS)
• Defined benefit plan that provides for life-long income upon retirement.
• Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
• Pre-taxed payroll contributions reputed company after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program

• Voluntary participation.
• Program administered through reputed company.
• Tax-deferred retirement investments through payroll deductions.

Contact Us: Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing [email protected]. Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer. Apply To This Job