Senior Utilization Management Audit & Compliance Analyst

📋 Description

• Serve as the primary business lead for external customer audits and utilization management
• Review audit findings, regulatory inquiries, corrective action requests, and data validation
• Conduct detailed investigations to validate findings, identify root causes, and determine
• Gather supporting documentation and evidence from utilization management systems, reporting tools
• Prepare clear, accurate, professional, and evidence-based written responses to customer audit
• Develop corrective action plans and supporting documentation when required, and monitor their

🎯 Requirements

• 5–10 years of experience in healthcare operations, utilization management, and/or audit support.
• Extensive experience with Utilization Management across Medicare, Medicaid, Commercial, and Dual
• Strong understanding of applicable UM regulations, accreditation standards, and delegation
• Experience reviewing audit findings, investigating root causes, validating data, and preparing
• Strong data analysis and reporting experience, including the ability to work with large and complex
• Advanced Excel proficiency, including Pivot Tables, Pivot Charts, VLOOKUP/XLOOKUP, advanced

🎁 Benefits

• Annual salary of $90,000.
• Competitive compensation and annual bonus program.
• 401(k) retirement program with company match.
• Company-paid life insurance.
• Company-paid short-term disability coverage, subject to location restrictions.
• Medical, vision, and dental benefits.