Senior Utilization Management Audit & Compliance Lead

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

Benefits offered by this job

Competitive compensation and annual-b​

401(k) retirement program with company

Company-paid life insurance

Company-paid short term disability

Medical, Vision, and Dental benefits

PTO

Parental Leave

Sick Time

Holidays and floating holidays

Quarterly company events

Health and wellness programs

Career development opportunities

Job summary

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits, review findings, and prepare evidence-based responses for health plans, regulators, and clients. The role requires strong UM knowledge across Medicare, Medicaid, commercial populations, and expertise in Essette and related systems.

The ideal candidate has 5–10 years in healthcare operations, UM, or audit support, with exceptional analytical and writing skills and advanced Excel

Qualifications

• Bachelor’s degree in healthcare administration, public health, or related field preferred.
• 5–10 years of healthcare operations, UM, and/or audit support experience.
• Excellent written and verbal communication skills, with attention to detail and accuracy.

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.
• 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.

Skills

Audit management

Regulatory compliance

Data analysis

Advanced Excel

Written communication

Cross-functional collaboration

Education

Bachelor's degree in healthcare administration

Tools

Essette UM system

Job description

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits, review findings, and prepare evidence-based responses for health plans, regulators, and clients. The role requires strong UM knowledge across Medicare, Medicaid, commercial populations, and expertise in Essette and related systems.

The ideal candidate has 5–10 years in healthcare operations, UM, or audit support, with exceptional analytical and writing skills and advanced Excel