Senior Utilization Management Audit & Compliance Analyst (Fully Remote)

Jobgether SRL; United States; Remote; USD 81,000 - 99,000; Full time

Job summary

Jobgether, a healthcare organization specializing in utilization management and regulatory compliance, seeks an experienced audit professional to support external audits and regulatory inquiries.

You will analyze UM data, prepare evidence-based responses for health plans and regulators, lead audit responses, and develop corrective action plans. Proficiency in Excel and strong communication are essential; remote work is available in the U.S.

Qualifications

• 5-10 years of healthcare operations or audit support experience.
• Knowledge of CMS, NCQA, and state regulatory UM requirements.
• Excellent written and verbal communication skills with attention to detail.

Responsibilities

• Serve as a subject matter expert for external customer audits and regulatory inquiries.
• Analyze utilization management data and prepare evidence-based responses for health plans, regulators, and accreditation organizations.
• Lead audit response activities and investigate UM records to validate findings.
• Develop corrective action plans and monitor implementation across teams.
• Use advanced Excel to analyze large datasets and create audit exhibits.

Skills

Communication skills

Attention to detail

Tools

Excel

Job description

• Serve as a subject matter expert for external customer audits and regulatory inquiries.
• Analyze utilization management data and prepare evidence-based responses for health plans, regulators, and accreditation organizations.

Key Responsibilities:

• Lead audit response activities and investigate UM records to validate findings.
• Develop corrective action plans and monitor implementation across teams.
• Use advanced Excel to analyze large datasets and create audit exhibits.

Requirements:

• 5-10 years of healthcare operations, utilization management, or audit support experience.
• Strong knowledge of CMS, NCQA, and state regulatory UM requirements.
• Excellent written and verbal communication skills with attention to detail.
• Annual salary of $90,000 plus competitive bonus and 401(k) match.
• Remote work available in select U.S. states with company-paid benefits and PTO.

Jobgether

This company is a healthcare organization specializing in utilization management and regulatory compliance. It operates with a remote team across the United States, fostering a collaborative and improvement-driven culture.