AHCCCS

Address: 150 North 18th Avenue Phoenix, Arizona 85007

All AHCCCS Employees must reside within the state of Arizona.

Salary: $100,000 - $110,000

Grade: 25

FLSA Status: Exempt

This position will remain open until filled.

The Audit Manager will report to the Inspector General. This position is responsible for the direct oversight 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, related to investigations of healthcare fraud and program mismanagement.

Major duties and responsibilities include but are not limited to:
• Provide leadership, direction, and oversight of the Quality Assurance Nurse Investigations Unit, including the recruitment, development, and performance management of staff. Ensure unit operations are fully aligned and consistent with Office of Inspector General (OIG) standards, policies, and procedures. Maintain and apply advanced clinical expertise to support and guide the execution of detailed and high-level complex 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 complex medical, financial, and operational AHCCCS regulations, as well as applicable federal and state laws, incorporating advanced clinical 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 all 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. Perform complex clinical, financial, and data analysis, and clearly document findings to support defensible outcomes and regulatory accountability.
• Negotiate and finalize determinations related 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, develop, and train staff, fostering a competent and high-performing workforce. Ensure planning activities are aligned 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 continuous improvement.
• Coordinate Liasionships internally and externally.

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, ADA, and workplace compliance

Skills:
• Leadership, supervision, and staff development
• Clinical review and advanced data analysis
• Data management, reporting, and Excel 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 oversight (including site visits)

Abilities:
• Lead, motivate, and develop high-performing teams
• Communicate clear expectations and align staff across functions
• Exercise sound judgment and decision-making under pressure
• Analyze, interpret, and synthesize complex data
• Manage competing priorities and make balanced decisions
• Apply clinical and investigative methodologies consistently
• Build cohesive teams and foster positive workplace culture
• Demonstrate integrity, 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 continuous improvement practices (LEAN, AMS, performance metrics)

• 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 rate is 75 percent. (d) Other limitations for FFP rate 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 related 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 capacity of a team lead or supervisor.

• Successfully pass fingerprint background check, 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 R2-10-207.12.) 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 within 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 current 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.

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

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-placed 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

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 begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program
• Voluntary participation.
• Program administered through Nationwide.
• Tax-deferred retirement investments through payroll deductions.

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.

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.