Jobs at Integra Partners

Leads external utilization management audits, regulatory inquiries, and compliance oversight across Medicare, Medicaid, Commercial, and Dual Eligible populations. Reviews UM records and audit findings, analyzes large datasets in Excel, validates regulatory timelines and performance metrics, drafts evidence-based responses, develops corrective action plans, and supports audit readiness. Partners with operational teams, clients, regulators, and accreditation organizations to resolve discrepancies, identify compliance risks, and improve processes.

Supports clinical utilization management teams with administrative processing of prior authorizations and appeals. Responsibilities include entering authorization requests, verifying eligibility and documentation, contacting providers, issuing notifications, completing verbal notifications, initiating appeals, documenting cases, and meeting regulatory deadlines. Requires knowledge of ICD-10, HCPCS codes, medical terminology, managed care processes, and strong organizational and communication skills.

Manages the corporate compliance program for payer services, including audits, fraud, waste and abuse investigations, compliance training, licensing, policy updates, risk assessments, and regulatory research. Partners with health plans, DME providers, internal teams, legal, and data security staff to address compliance and security concerns. Oversees a compliance analyst and supports HIPAA, CMS, Medicare, Medicaid, credentialing, and healthcare regulatory obligations.

Leads complex post-sale health plan implementations from kickoff through launch, stabilization, and operational handoff. Owns project plans, client relationships, cross-functional coordination, risks, decisions, testing, claims workflow validation, issue resolution, readiness, documentation, and executive reporting. The role requires direct payer implementation and healthcare claims experience, strong facilitation and communication skills, and the ability to drive accountability across teams. It also mentors junior staff and improves implementation processes, templates, and standards.

Leads architecture, development, and delivery of scalable healthcare applications using .NET, Azure, Kubernetes, SQL Server, and modern web technologies. Provides technical leadership, mentors engineers, conducts code reviews, manages production issues, optimizes database performance, and guides sprint execution across multiple initiatives.

Lead the design, development, and modernization of enterprise healthcare EDI and FHIR integration solutions. Define architecture standards, develop X12, HL7, and FHIR integrations, build transformation and validation frameworks, and guide migration to microservices, event-driven, cloud-native systems. Partner with DevOps and SRE teams on CI/CD, observability, scalability, reliability, and production troubleshooting. Mentor engineers and collaborate with product, engineering, business, and vendor teams.

Lead payer-focused business development to grow Integra's payer client book. Build pipeline, engage senior health plan decision-makers, close deals, support implementations, forecast revenue, and collaborate cross-functionally. Travel up to 50% for conferences.