Senior Utilization Management Audit Lead

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

Benefits offered by this job

401(k) retirement program with company

Company-paid life insurance

Medical, Vision, and Dental benefits

Paid Time Off (PTO)

Paid Parental Leave

Sick Time

Holidays and floating holidays

Career development opportunities

Job summary

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits, respond to inquiries, and oversee UM oversight activities. You will analyze large UM data, validate findings in Essette, and craft evidence-based responses for plans and regulators.

The role requires 5–10 years in healthcare operations or UM, strong writing skills, and advanced Excel proficiency to support audit readiness and compliance initiatives.

Qualifications

• Extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible populations.
• Strong understanding of UM regulations, accreditation standards, and delegation requirements.
• Experience preparing reports and analyzing data for audits.
• Advanced Excel proficiency for large data set analysis and trend detection.
• Excellent written and verbal communication with attention to accuracy.

Responsibilities

• Serve as the primary lead for external audits and oversight reviews.
• Review findings, inquiries, and data validation requests from plans and regulators.
• Draft professional written responses and develop corrective action plans.
• Conduct detailed UM data reviews and validate determinations within Essette.
• Identify trends and opportunities for process improvements and audit readiness.

Skills

Utilization Management

Regulatory knowledge

Analytical skills

Excel

Written communication

Cross-functional collaboration

Education

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

Tools

Essette

Job description

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits, respond to inquiries, and oversee UM oversight activities. You will analyze large UM data, validate findings in Essette, and craft evidence-based responses for plans and regulators.

The role requires 5–10 years in healthcare operations or UM, strong writing skills, and advanced Excel proficiency to support audit readiness and compliance initiatives.