Sr Utilization Management Audit & Compliance Lead-Remote

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

Benefits offered by this job

Competitive compensation and annualBON

401(k) with company match

Company-paid life insurance

Short term disability coverage

Medical, Vision, and Dental benefits

PTO

Parental Leave

Sick Time

Holidays & floating holidays

Quarterly events

Health and wellness programs

Career development opportunities

Job summary

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits, respond to regulatory inquiries, and oversee UM processes. You will analyze data in Essette and other systems, validate findings, and prepare professional responses for health plans and regulators.

The role requires extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible populations, strong Excel skills, and exceptional written and verbal communication.

Qualifications

• 5–10 years of experience in healthcare operations, UM, and/or audit support.
• Strong 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 primary lead for external customer audits and oversight reviews.
• Review audit findings, inquiries, and data validation requests from health plans and regulators.
• Conduct investigations to validate findings and determine root causes.
• Draft clear, evidence-based responses and develop corrective action plans.
• Analyze UM data to support audits and performance reviews.

Skills

Audit management

Regulatory knowledge

Analytical writing

Advanced Excel

Data analysis

Cross-functional collaboration

Education

Bachelor’s degree in healthcare administration/public health

Tools

Essette

Excel (Advanced)

Job description

Integra Partners is seeking a Senior Utilization Management Audit & Compliance Analyst to lead external audits, respond to regulatory inquiries, and oversee UM processes. You will analyze data in Essette and other systems, validate findings, and prepare professional responses for health plans and regulators.

The role requires extensive UM experience across Medicare, Medicaid, Commercial, and Dual Eligible populations, strong Excel skills, and exceptional written and verbal communication.