Senior RN Clinical Compliance Auditor - Remote, Growth

Guidehealth; EE. UU.; A distancia; USD 82.000 - 87.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Work from Home

401(k) plan with 3% employer match

Life and Disability insurance

Paid time off

Parental leave

Descripción de la vacante

Guidehealth, a remote-first healthcare company, is seeking a Clinical Compliance Auditor II to ensure compliance across clinical operations, utilization management, and delegated services. The role partners with Clinical Leadership, Compliance, and Operations to identify risks and drive improvements in quality and regulatory readiness.

The position offers autonomy, mentorship opportunities, and cross-functional collaboration within a growing organization focused on value-based care and patient

Formación

• RN license required.
• 3–5 years in utilization management, clinical auditing, clinical compliance, or managed care.
• Knowledge of Medicare, Commercial Managed Care, and delegated services compliance requirements.
• Proficient with Microsoft Office (Excel, Word) and reporting tools.

Responsabilidades

• Conduct comprehensive clinical compliance audits including utilization management, denial documentation, and reporting.
• Monitor adherence to UM/PHM Plans, MSAs, and client requirements.
• Perform routine and ad hoc audits to assess regulatory compliance.
• Serve as secondary reviewer for denial documentation.
• Identify trends and risks from audit findings to drive improvements.
• Prepare and present audit findings to clinical leadership.

Conocimientos

RN license

Utilization management

Clinical auditing

Regulatory compliance

Independent work

Microsoft Office

Herramientas

Excel

Word

Reporting tools

Descripción del empleo

Guidehealth, a remote-first healthcare company, is seeking a Clinical Compliance Auditor II to ensure compliance across clinical operations, utilization management, and delegated services. The role partners with Clinical Leadership, Compliance, and Operations to identify risks and drive improvements in quality and regulatory readiness.

The position offers autonomy, mentorship opportunities, and cross-functional collaboration within a growing organization focused on value-based care and patient