Senior Clinical Compliance Auditor (RN) - Remote

SmartRecruiters, Inc.; Dallas (TX); Remote; USD 82,000 - 87,000; Full time

Benefits offered by this job

Remote work

401(k) match

Health benefits

Paid time off

Parental leave

Job summary

Guidehealth, a data-powered healthcare company, seeks a Clinical Compliance Auditor II to ensure adherence to UM/PHM plans and regulatory standards. You will conduct audits, mentor staff, and help refine audit tools within a remote-friendly, collaborative team.

The role requires RN licensure, 3–5 years in utilization management or clinical auditing, and strong regulatory knowledge. Expect growth, mentorship, and cross-functional partnership across Clinical Leadership and Operations.

Qualifications

• Active, unrestricted RN license.
• Knowledge of utilization management processes, 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 requirements.
• 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 UM, denial documentation, clinical reporting, authorization compliance, and delegated services requirements.
• Monitor adherence to UM/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.
• Assist in developing and maintaining audit tools, protocols, and compliance monitoring frameworks.
• Prepare and present audit findings and compliance reports to leadership and stakeholders.

Skills

RN license

Regulatory compliance

Clinical auditing

Analytical thinking

Independent judgment

Regulatory reporting

Tools

Microsoft Office (Excel, Word)

Job description

Guidehealth, a data-powered healthcare company, seeks a Clinical Compliance Auditor II to ensure adherence to UM/PHM plans and regulatory standards. You will conduct audits, mentor staff, and help refine audit tools within a remote-friendly, collaborative team.

The role requires RN licensure, 3–5 years in utilization management or clinical auditing, and strong regulatory knowledge. Expect growth, mentorship, and cross-functional partnership across Clinical Leadership and Operations.