Senior Clinical Compliance Auditor II – Remote

Guidehealth; Dallas (TX); Remote; USD 82,000 - 87,000; Full time

Benefits offered by this job

Work from home

Medical, Dental, Vision plans

401(k) with company match

Life and Disability insurance

Employee Assistance Program

Paid time off

Paid parental leave

Learning and development resources

Job summary

Guidehealth seeks a Clinical Compliance Auditor II to ensure our clinical operations and delegated services meet regulatory and client requirements. You will audit, monitor, and validate compliance with UM and PHM plans while collaborating with Clinical Leadership and Operations.

You will mentor staff, drive process improvements, and help strengthen our compliance framework in a remote, agile environment with opportunities to grow within a mission-driven team.

Qualifications

• Active, unrestricted RN license required.
• Strong knowledge of utilization management, clinical documentation, and regulatory compliance.
• 3–5 years of experience in utilization management, clinical auditing, clinical compliance, or managed care.
• Knowledge of Medicare, Commercial Managed Care, and delegated services compliance.
• Ability to work independently and exercise sound professional judgment.
• Proficiency with Microsoft Office, including Excel, Word, and reporting tools.

Responsibilities

• Conduct comprehensive clinical compliance audits, including utilization management, denial documentation, clinical reporting, authorization compliance, and delegated services requirements.
• Monitor adherence to UM and PHM Plans, MSAs, and client-specific regulatory requirements.
• Perform routine, scheduled, and ad hoc audits to assess compliance with internal policies and client obligations.
• Serve as a secondary reviewer for denial documentation to ensure regulatory and contractual compliance.
• Monitor audit findings to identify trends, risks, and opportunities for improvement.
• Support development of audit tools, protocols, and compliance monitoring frameworks.
• Prepare and present audit findings to clinical leadership and stakeholders.

Skills

RN license

Regulatory knowledge

UM experience

Healthcare auditing

Medicare/Managed care

Independent judgment

MS Office

Auditing

Tools

Excel

Word

Reporting tools

Job description

Guidehealth seeks a Clinical Compliance Auditor II to ensure our clinical operations and delegated services meet regulatory and client requirements. You will audit, monitor, and validate compliance with UM and PHM plans while collaborating with Clinical Leadership and Operations.

You will mentor staff, drive process improvements, and help strengthen our compliance framework in a remote, agile environment with opportunities to grow within a mission-driven team.