Senior Utilization Management Audit & Compliance Lead

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

Benefits offered by this job

Annual bonus

401(k) match

Life insurance

Short-term disability

Medical, Vision, and Dental

PTO

Parental leave

Holidays & floats

Company events

Wellness programs

Career development

Job summary

Integra Partners is hiring a Senior Utilization Management Audit & Compliance Analyst. The role focuses on audits, regulatory inquiries, and UM oversight, including responding to health plans and regulators with evidence-based analyses.

The ideal candidate brings extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible populations, with strong Excel skills and a track record of process improvements. Remote work options are available within the U.S.

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, with strong attention to detail.

Responsibilities

• Lead external customer audits and oversight reviews.
• Review findings, inquiries, and data validation requests from health plans and regulators.
• Draft professional written responses and develop corrective action plans as needed.
• Analyze UM data to support audits and business reviews.
• Identify trends and opportunities for process improvements.

Skills

Advanced Excel

Analytical thinking

Written communication

Verbal communication

Project coordination

Cross-functional collaboration

Education

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

Tools

Essette

PivotTables / VLOOKUP / XLOOKUP

Job description

Integra Partners is hiring a Senior Utilization Management Audit & Compliance Analyst. The role focuses on audits, regulatory inquiries, and UM oversight, including responding to health plans and regulators with evidence-based analyses.

The ideal candidate brings extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible populations, with strong Excel skills and a track record of process improvements. Remote work options are available within the U.S.