Senior Utilization Management Audit & Compliance Analyst

About the Role:

• Serve as a subject matter expert for external customer audits and regulatory inquiries.
• Analyze utilization management data and prepare evidence-based responses for health plans, regulators, and accreditation organizations.

Key Responsibilities:

• Lead audit response activities and investigate UM records to validate findings.
• Develop corrective action plans and monitor implementation across teams.
• Use advanced Excel to analyze large datasets and create audit exhibits.

Requirements:

• 5-10 years of healthcare operations, utilization management, or audit support experience.
• Strong knowledge of CMS, NCQA, and state regulatory UM requirements.
• Excellent written and verbal communication skills with attention to detail.

Benefits:

• Annual salary of $90,000 plus competitive bonus and 401(k) match.
• Remote work available in select U.S. states with company-paid benefits and PTO.