Remote Senior UM Audit & Compliance Lead

Integra Partners; New Jersey; On-site; USD 81,000 - 99,000; Full time

Benefits offered by this job

401(k) retirement program with company

Company-paid life insurance

Medical, Vision, and Dental benefits

Paid Time Off (PTO)

Paid Parental Leave

Sick Time

Holidays and floating holidays

Quarterly events

Health and wellness programs

Career development opportunities

Job summary

Integra Partners seeks a Senior Utilization Management Audit & Compliance Analyst to lead external audits and oversee regulatory inquiries. You will analyze large UM datasets in Essette and related systems, validate findings, and craft evidence-based responses for health plans and regulators.

Strong Excel skills and 5–10 years of UM/audit experience are required. Ideal candidates combine deep UM regulatory knowledge with excellent written communication and cross-functional collaboration to drive

Qualifications

• Bachelor’s degree in healthcare admin, public health, or related field preferred.
• 5-10 years of experience in healthcare operations, UM, and/or audit support.
• Strong writing and verbal communication skills with attention to detail.

Responsibilities

• Serve as the primary business lead for external customer audits and oversight reviews.
• Review audit findings, inquiries, corrective action requests, and data validation requests from health plans, clients, and regulatory agencies.
• Conduct comprehensive investigations to validate audit findings and determine root causes.
• Gather supporting documentation and evidence from UM systems, reporting tools, and operational teams.
• Draft clear, accurate, and professional written responses to customer audit findings.
• Develop corrective action plans and supporting documentation when appropriate.
• Ensure audit responses are completed accurately and within required timelines.
• Assist in customer meetings related to audit findings and performance reviews.
• Track recurring issues and recommend process improvements.
• Support implementation and monitoring of corrective action plans.

Skills

Audit management

Data analysis

Regulatory compliance

Communication

Documentation

Education

Bachelor’s degree preferred

Tools

Essette

Excel

Job description

Integra Partners seeks a Senior Utilization Management Audit & Compliance Analyst to lead external audits and oversee regulatory inquiries. You will analyze large UM datasets in Essette and related systems, validate findings, and craft evidence-based responses for health plans and regulators.

Strong Excel skills and 5–10 years of UM/audit experience are required. Ideal candidates combine deep UM regulatory knowledge with excellent written communication and cross-functional collaboration to drive