MI Coordinated Health Auditor - Team Manager

MPHI is a Michigan-based and nationally engaged, non-profit public health institute. We are a team of teams, process and content experts, dedicated to building A world where tomorrow is healthier than today!

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.

• 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.

• 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.

• 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.

• 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.

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.

MPHI works with you to promote health for everyone. Together, we will build a world where tomorrow is healthier than today!

MPHI is an EEO employer that participates with e-verify.