Senior Utilization Management Audit & Compliance Lead

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

Benefits offered by this job

401(k) retirement program with company

Medical, Vision, and Dental benefits

Paid Time Off (PTO)

Bonus program

Job summary

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to serve as the subject matter expert for external audits and regulatory inquiries. You will review requests, analyze UM data in Essette and related systems, and prepare evidence-based responses for health plans, clients, regulators, and accreditation bodies.

The ideal candidate has extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible populations, with strong regulatory

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.
• Ability to build strong 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 investigations to validate audit findings and determine root causes.
• Draft clear, accurate written responses to customer audit findings and develop corrective action plans.
• Ensure audit responses are completed accurately within required timelines.
• Assist in customer meetings related to audit findings and performance reviews.

Skills

Utilization Management

Excel proficiency

Analytical skills

Written communication

Cross-functional collaboration

Attention to detail

Education

Bachelor's degree in healthcare administration

Tools

Essette

Job description

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to serve as the subject matter expert for external audits and regulatory inquiries. You will review requests, analyze UM data in Essette and related systems, and prepare evidence-based responses for health plans, clients, regulators, and accreditation bodies.

The ideal candidate has extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible populations, with strong regulatory