Clinical Compliance Auditor

Job not on LinkedIn

🔥 4 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $82k - $87k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 Ghost score 11%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Guide Healthcare

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2018

⚕️ Healthcare Insurance

🏥 Healthcare

🎯 Recruiter

Healthcare Insurance • Healthcare • Recruitment

Guide Healthcare is leading a movement where creativity delivers positive change in the healthcare sector. The company specializes in allied health service provision and healthcare recruitment, focusing on the support and treatment of older adults. With a commitment to adding value to their clients, partners, and teams, Guide Healthcare aims to do things differently in the industry.

📋 Description

• Conduct comprehensive clinical compliance audits covering utilization management, denial documentation, clinical reporting, authorization compliance, and delegated services requirements • Monitor adherence to UM and PHM Plans, Managed Services Agreements, and client-specific contractual and regulatory requirements • Perform routine, scheduled, and ad hoc audits • Serve as a secondary reviewer for denial documentation • Monitor audit findings, clinical workflows, and reporting processes to identify trends, risks, documentation deficiencies, and process gaps • Develop and maintain audit tools, protocols, compliance monitoring frameworks, UM and PHM Plans, and clinical compliance procedures • Provide mentorship, guidance, and subject matter expertise to Clinical Compliance Auditors and clinical operations staff • Support leadership with training needs and clinical compliance improvement opportunities • Facilitate audit reviews, reporting processes, and compliance committee support activities • Analyze audit results and clinical data to identify trends and root causes • Prepare and present audit findings and compliance reports to clinical leadership and operational stakeholders • Support development of reporting tools, dashboards, and audit metrics • Adapt to evolving business needs and support cross-functional initiatives

🎯 Requirements

• Active, unrestricted Registered Nurse (RN) license required • Strong knowledge of utilization management processes, clinical documentation, and regulatory compliance requirements • Minimum of 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 • Minimum of 2 years of clinical compliance auditing or healthcare auditing experience preferred • Ability to provide and maintain required internet connection of at least 100 Mbps download and 10 Mbps upload • Must be accessible during stated working hours • Must follow security policies and procedures protecting PHI, PII, and company intellectual property

🏖️ Benefits

• Fully remote work arrangement • Necessary work equipment provided at no charge • Comprehensive Medical, Dental, and Vision plans • 401(k) plan with a 3% employer match to 6% employee contribution • Life and Disability insurance • Voluntary Life options • Employee Assistance Program (EAP) • Paid time off plans • Paid parental leave • Learning and development resources • Flexible work arrangement • Employees provide their own internet connection; minimum 100 Mbps download and 10 Mbps upload required