Senior Utilization Management Audit & Compliance — Remote

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

Benefits offered by this job

Competitive compensation and annualBON

401(k) with company match

Medical, Vision, and Dental benefits

Paid Time Off (PTO)

Parental Leave

Sick Time

Paid holidays and floating holidays

Career development opportunities

Quarterly company-sponsored events

Job summary

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits and respond to inquiries. The role demands expertise in Medicare/Medicaid/Commercial populations, strong regulatory knowledge, and advanced Excel skills.

You will review UM data in Essette, draft professional responses, and drive corrective actions with cross-functional teams. The position emphasizes compliance, audit readiness, and clear communication with health plans, regulators, and

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 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

Auditing

Analytical skills

Written communication

Communication

Data analysis

Regulatory knowledge

Excel proficiency

Essette system

Education

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

Tools

Essette

UM systems

Excel (Advanced)

Job description

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits and respond to inquiries. The role demands expertise in Medicare/Medicaid/Commercial populations, strong regulatory knowledge, and advanced Excel skills.

You will review UM data in Essette, draft professional responses, and drive corrective actions with cross-functional teams. The position emphasizes compliance, audit readiness, and clear communication with health plans, regulators, and