Healthcare Quality Analyst (Utilization Management)

About the role

The Healthcare Quality Analyst (Utilization Management) monitors and improves the quality of utilization management activities performed by the UM Operations team. This non‑clinical position conducts audits, provides coaching, and supports process‑improvement initiatives to ensure compliance with client policies, regulatory standards, and service level agreements.

Key responsibilities

• Conduct quality audits of authorizations, referrals, fax intake, and documentation.
• Evaluate work against quality standards, client SOPs, and business rules.
• Identify errors, documentation gaps, and workflow deficiencies.
• Score audits, provide written feedback, and track performance trends.
• Deliver coaching sessions and partner with training to address knowledge gaps.
• Prepare daily, weekly, and monthly quality reports and present findings to leadership.
• Maintain audit documentation while protecting PHI and ensuring HIPAA, CMS, NCQA, and URAC compliance.
• Support policy updates, workflow changes, and new process implementations.

Required profile

• High School Diploma required; Associate’s or Bachelor’s degree preferred.
• 2–3 years of experience in quality auditing, utilization management, or related call‑center operations.
• Strong understanding of HIPAA, CMS, NCQA, and URAC requirements.

Required skills

What we offer

• On‑site work with potential remote option after training.
• Opportunities for professional development in a healthcare call‑center environment.