Senior Utilization Management Analyst

Job Summary

Serving as the subject matter expert for external customer audits and regulatory inquiries, the full-time remote Senior Utilization Management Audit & Compliance Analyst will manage audit requests, perform detailed analyses of utilization management data, and prepare evidence-based responses for health plans and regulatory bodies.

Key responsibilities

• Lead external customer audits and oversight reviews, ensuring timely and accurate responses to audit findings
• Conduct detailed reviews of authorization records and validate compliance with regulatory requirements
• Analyze utilization management data using advanced Excel functions to support audits and identify operational improvements

Required qualifications

• Bachelor's degree in healthcare administration, public health, or a related field preferred
• 5-10 years of experience in healthcare operations, utilization management, and/or audit support
• Strong understanding of UM regulations and accreditation standards
• Proficiency in advanced Excel functions for data analysis
• Ability to build strong cross-functional relationships across Operations, IT, and external clients