Senior RN: Clinical Compliance Auditor — Remote

Guidehealth; Oregon; Híbrido; USD 82.000 - 87.000; Tempo integral

Benefícios oferecidos por esta vaga

Work from home

Medical, Dental, Vision plans

401(k) with employer match

Life and Disability insurance

Employee Assistance Program (EAP)

Paid time off

Paid parental leave

Learning and development

Resumo da vaga

Guidehealth, a data-powered healthcare company, seeks a Clinical Compliance Auditor II to lead complex audits ensuring UM/PHM and delegated services meet regulatory standards. You will mentor staff, collaborate with Clinical Leadership, and enhance audit tools and processes.

Qualifications include an active RN license and 3–5 years in utilization management or clinical auditing. Experience with Medicare/commercial plans is preferred. This is a fully remote role.

Qualificações

• Active, unrestricted RN license required.
• Strong knowledge of utilization management processes and regulatory compliance.

Responsabilidades

• Conduct comprehensive clinical compliance audits across UM/PHM and delegated services.
• Monitor adherence to UM/PHM Plans and MSAs and client requirements.
• Mentor and guide junior auditors and clinical operations staff.
• Analyze audit results to identify trends and improvement opportunities.

Conhecimentos

RN license

Regulatory compliance

Auditing skills

Independent judgment

Microsoft Office (Excel, Word)

Reporting tools

Ferramentas

Microsoft Excel

Microsoft Word

Reporting tools

Descrição da vaga

Guidehealth, a data-powered healthcare company, seeks a Clinical Compliance Auditor II to lead complex audits ensuring UM/PHM and delegated services meet regulatory standards. You will mentor staff, collaborate with Clinical Leadership, and enhance audit tools and processes.

Qualifications include an active RN license and 3–5 years in utilization management or clinical auditing. Experience with Medicare/commercial plans is preferred. This is a fully remote role.