Senior Utilization Management Audit & Compliance Lead

Integra Partners; Illinois; Remote; USD 81,000 - 99,000; Full time

Benefits offered by this job

Competitive compensation

401(k) with company match

Company-paid life insurance

Short term disability coverage

Medical, Vision, and Dental benefits

PTO

Parental Leave

Sick Time

Holidays & floating holidays

Wellness programs

Career development opportunities

Job summary

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits, respond to regulators, and oversee UM data investigations. You will review requests, validate findings in Essette, and prepare professional responses for health plans and stakeholders.

The ideal candidate has extensive UM experience across Medicare/Medicaid/Commercial, strong regulatory knowledge, and advanced Excel skills to analyze large datasets and support audit readiness.

Qualifications

• Bachelor’s degree in healthcare administration, public health, or related field preferred.
• 5–10 years of experience in healthcare operations, UM, and/or audit support.
• Excellent written and verbal communication skills with attention to detail and accuracy.
• Advanced Excel skills for analyzing large data sets (Pivot Tables, VLOOKUP/XLOOKUP, charts).
• Ability to build cross-functional relationships across Operations, IT, and external clients.

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

Utilization Management

Advanced Excel

Data analysis

Regulatory understanding

Audit coordination

Education

Bachelor's degree in healthcare administration or related field

Tools

Essette UM system

Pivot Tables / Excel

Data reporting tools

Job description

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits, respond to regulators, and oversee UM data investigations. You will review requests, validate findings in Essette, and prepare professional responses for health plans and stakeholders.

The ideal candidate has extensive UM experience across Medicare/Medicaid/Commercial, strong regulatory knowledge, and advanced Excel skills to analyze large datasets and support audit readiness.