Remote Senior Utilization Audit & Compliance Analyst

Integra Partners; Pennsylvania; Hybrid; USD 81,000 - 99,000; Full time

Benefits offered by this job

401(k)

Life insurance

Health benefits

PTO

Parental leave

Sick time

Holidays

Career development

Job summary

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to serve as the subject matter expert for external audits, regulatory inquiries, and UM oversight. You will review audit requests, analyze UM data in Essette, and prepare professional, evidence-based responses for health plans, clients, regulators, accreditation bodies, and other external stakeholders.

The ideal candidate brings extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible

Qualifications

• The Senior UM Audit & Compliance Analyst leads external audits and oversight reviews and compiles evidence-based responses.
• Strong understanding of UM regulations, accreditation standards, and delegation requirements.
• Extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible populations.
• Excellent writing and communication skills with advanced Excel proficiency.
• Ability to analyze large datasets and identify trends to support audit readiness.

Responsibilities

• Audit Management & Customer Response: lead external audits and respond to inquiries, develop corrective actions, ensure timely responses.
• UM System Review & Investigation: review Essette records, validate determinations, research findings, resolve discrepancies.
• Data Analysis & Reporting: analyze UM data, create summaries, reports, and audit exhibits; identify trends.
• Utilization Management Compliance: interpret UM requirements across populations; monitor CMS/NCQA/regulatory adherence.
• Process Improvement & Audit Readiness: develop tools/templates, establish tracking, participate in mock audits.

Skills

Analytical

Writing skills

Communication

Excel

Data analysis

Education

Bachelor’s degree in healthcare administration, public health, or related field

Tools

Essette

Job description

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to serve as the subject matter expert for external audits, regulatory inquiries, and UM oversight. You will review audit requests, analyze UM data in Essette, and prepare professional, evidence-based responses for health plans, clients, regulators, accreditation bodies, and other external stakeholders.

The ideal candidate brings extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible