Current Michigan licensure as a Registered Nurse, Nurse Practitioner, Practical Nurse, Physician Assistant, or Social Worker
Minimum 1 year experience with elderly or adults with disabilities
Experience in auditing and regulatory compliance
3-5 years of supervisory experience
Valid driver's license
Responsibilities
Oversee the MICH audit team and ensure regulatory compliance
Enhance audit protocols and training materials
Coordinate annual audit timelines and prepare end-of-audit reports
Conduct audits through record reviews and home visits
Report findings to stakeholders including the State and leadership
Facilitate team meetings and provide guidance to staff
Analyze and document audit results and review Corrective Action Plans
Benefits
Hybrid work arrangement
Opportunity for professional development
Team-oriented work environment
Engagement with diverse stakeholders
Potential for community impact through work with Integrated Care Organizations
Full Job Description
Job Title:
MI Coordinated HealthAuditor Team Manager
Location:
Hybrid - Must work and live in the state of Michigan
Pay Range:
$74,909.84 - $89,892.22
Posted Thru:
11-12-26
Purpose
This position will be responsible for auditing the compliance of Highly Integrated Dual Eligible Special Needs Plans (HIDE-SNPs) participating in the MI Coordinated Health c-waiver program. to determine compliance and involves record reviews, home visit interviews, report writing, presentations, training and licensing verifications, monitoring of corrective action plans (CAPs), and critical incident reviews. The position also supervises the team responsible for developing, implementing, and enhancing auditing processes to ensure regulatory compliance for Integrated Care Organizations.
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.
Coordinate 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.
Additional duties as assigned.
Qualifications/Requirements
Bachelor's degree with 5-7 years of experience.
Preferred education - Current Michigan licensure as a Registered Nurse, Licensed Nurse Practitioner, Licensed Practical Nurse, Licensed Physician Assistant. A bachelor's prepared Social Work, 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 required.
Valid drivers license.
Important 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.
Travel to particpants 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.
