Senior Utilization Management Audit Lead

Integra Partners; Texas; 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

PTO

Parental Leave

Holidays and wellness programs

Career development opportunities

Job summary

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits and respond to regulator inquiries. The role requires deep UM experience across Medicare, Medicaid, Commercial, and Dual Eligible populations, with strong Excel skills and a focus on data-driven audit responses.

Responsibilities include reviewing audit findings, creating corrective actions, and ensuring timeliness.

Qualifications

• The role requires 5–10 years in healthcare operations, UM, or audits.
• Strong writing skills and attention to detail for audit responses.
• Ability to interpret CMS, NCQA, and state regulatory requirements.

Responsibilities

• Lead external customer audits and oversight reviews.
• Review findings, inquiries, and corrective action requests.
• Investigate to validate findings and determine root causes.
• Prepare professional written responses and supporting documentation.
• Develop corrective action plans and monitor implementation.
• Analyze UM data to support audits and inquiries.

Skills

Audit management

Data analysis

Regulatory knowledge

Excellent written/verbal communication

Advanced Excel

Education

Bachelor’s degree in healthcare administration or related

Tools

Essette

UM data systems

Job description

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits and respond to regulator inquiries. The role requires deep UM experience across Medicare, Medicaid, Commercial, and Dual Eligible populations, with strong Excel skills and a focus on data-driven audit responses.

Responsibilities include reviewing audit findings, creating corrective actions, and ensuring timeliness.