Senior Utilization Management Analyst

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