Remote Senior UM Audit & Compliance Strategist

Integra Partners; Northern (KY); Hybrid; USD 81,000 - 99,000; Full time

Benefits offered by this job

401(k) retirement program

Company-paid life insurance

Medical, Vision, and Dental benefits

Paid Time Off

Paid Parental Leave

Sick Time

Holidays and events

Career development opportunities

Job summary

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits, respond to regulatory inquiries, and oversee UM processes. You will review data in Essette, validate findings, and prepare evidence-based responses for health plans and regulators.

The ideal candidate has extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible populations, with strong analytical, writing, and communication skills and advanced Excel proficiency

Qualifications

• Lead external audits and oversight reviews for health plans and regulators.
• Review audit findings, inquiries, and data validation requests.
• Investigate audit findings to determine root causes and prepare professional responses.

Responsibilities

• Review authorization records, determinations, and timelines in Essette.
• Validate regulatory time frames and documentation requirements.
• Research audit findings using system data and supporting records.
• Collaborate with operations to resolve discrepancies and provide documentation.
• Ensure audit findings are supported by accurate data.

Skills

Audit management

Data analysis

Excel proficiency

Regulatory knowledge

Communication skills

Cross-functional collaboration

Education

Bachelor's degree in healthcare administration

Tools

Essette

Pivot Tables

XLOOKUP

Job description

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits, respond to regulatory inquiries, and oversee UM processes. You will review data in Essette, validate findings, and prepare evidence-based responses for health plans and regulators.

The ideal candidate has extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible populations, with strong analytical, writing, and communication skills and advanced Excel proficiency