MI Coordinated Health Auditor - Team Manager

Duties And Responsibilities

• Oversee a MICH team to ensure effective execution of audit processes and compliance with regulatory requirements.
• Make recommendations on enhancements to audit protocols, tools, and training materials to support audit activities.
• Cookordinate and monitor yearly audit timelines and assist with end-of-audit reports.
• Conduct audits through record reviews, entrance conferences, desk audits, and home visits to verify compliance with program standards.
• Report audit progress and communicate findings to stakeholders including Integrated Care Organizations, the State, and internal leadership.
• Facilitate team meetings, organize and assign audit tasks, and provide guidance and training to new staff members.
• Develop and update audit presentations, protocols, and objective audit tools for both internal use and Integrated Care Organization preparation.
• Analyze audit results, document findings in comprehensive reports, and review Corrective Action Plans from Integrated Care Organizations.
• Initiate, respond to, and track communications with the State and other relevant entities to ensure timely resolution of audit issues.
• Implement process improvement initiatives to enhance overall audit effectiveness and efficiency.
• Collaborate with other auditors to refine and improve auditing methodologies and practices.
• Represent the best interests of MPHI at all times.

Qualifications/Requirements

• Bachelor's degree with 5-7 years of experience.
• Current Michigan licensure as a Registered Nurse, Licensed Nurse Practitioner, Licensed Practical Nurse, Licensed Physician Assistant, Bachelor's prepared Social Worker, or Master's prepared Social Worker.
• Minimum 1 year experience working with elderly individuals or adults with disabilities.
• Experience in auditing and regulatory compliance required.
• 3-5 years of supervison experience.
• Valid drivers license.

Additional Skills And Characteristics

• Demonstrates up-to-date clinical skills and a comprehensive understanding of medical terminology, common diseases, and interventions.
• Possesses knowledge of Medicare and Medicaid and the regulatory frameworks impacting Integrated Care Organizations.
• Proficient in reading and analyzing medical records to assess enrollee needs and risks.
• Exhibits critical thinking skills with the ability to interpret and translate federal and state regulations into actionable audit findings.
• Demonstrates competence in using standard office software to document, analyze, and report audit data.
• Familiarity with state data systems and experience in home-and-community-based services programming preferred.
• Ability to work independently with minimal feedback while consistently adhering to audit protocols preferred.

Physical Demands

• Constantly required to exchange accurate information.
• Constantly operates a computer and other office machinery.
• Constantly observes details at close range.
• Frequently remains in a stationary position.
• Occasionally moves about inside an office.
• Occasionally moves office equipment weighing up to 25 pounds.
• Occasionally travels to participants' homes for inverviews.

Work Environment

• This job is performed in an indoor office environment and involves regular use of computers and other standard office equipment.
• The work environment may include limited exposure to moderate noise levels.
• Travel required.