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Senior Utilization Management Audit & Compliance Analyst

Integra Partners • Remote, US • published 2026-10-01 03:58:50.009028

Description

The Senior Utilization Management Audit \& Compliance Analyst serves as the subject matter expert for external customer audits, regulatory inquiries, and utilization management oversight activities. This position is responsible for reviewing audit requests, performing detailed analyses of utilization management data, researching findings within the UM system, Essette, and related systems, and preparing professional, evidence\-based responses for health plans, clients, regulators, accreditation organizations, and other external stakeholders. The ideal candidate possesses extensive Utilization Management experience across Medicare, Medicaid, Commercial, and Dual Eligible populations and maintains a strong understanding of applicable UM regulations, accreditation standards, and delegation requirements. This role requires exceptional analytical, writing, and communication skills, along with advanced Excel proficiency to analyze large data sets, identify trends, validate findings, and support audit responses. **JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES** The Senior Utilization Management Audit \& Compliance Analyst’s responsibilities include but are not limited to: **Audit Manageme...

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