Remote Utilization Management Audit & Compliance Analyst

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

Benefits offered by this job

401(k) retirement program

Life insurance

Medical, Vision, and Dental benefits

Paid Time Off

Parental Leave

Sick Time

Paid holidays

Job summary

Integra Partners in the United States seeks a Senior Utilization Management Audit & Compliance Analyst to serve as the expert for external audits, regulatory inquiries, and UM oversight. You will review audit requests, analyze UM data in Essette, and prepare professional responses for health plans and regulators.

The ideal candidate has 5–10 years in healthcare operations with strong CMS/NCQA knowledge, and advanced Excel skills to identify trends, validate findings, and support audit readiness.

Qualifications

• 5–10 years in healthcare operations, UM, and/or audit support.
• Strong writing, communication, and organizational skills.
• Experience coordinating with health plans, regulators, and clients.

Responsibilities

• Lead external audits and oversight reviews; prepare responses.
• Review findings, data validation requests, and action plans.
• Analyze UM data and generate audit exhibits and reports.
• Ensure regulatory timeframes and documentation requirements are met.

Skills

Utilization Management

Data analysis

Regulatory knowledge

Excel proficiency

Audit responses

Education

Bachelor's degree in healthcare administration

Tools

Essette

UM systems

Job description

Integra Partners in the United States seeks a Senior Utilization Management Audit & Compliance Analyst to serve as the expert for external audits, regulatory inquiries, and UM oversight. You will review audit requests, analyze UM data in Essette, and prepare professional responses for health plans and regulators.

The ideal candidate has 5–10 years in healthcare operations with strong CMS/NCQA knowledge, and advanced Excel skills to identify trends, validate findings, and support audit readiness.