Registered Nurse, Clinical Compliance Auditor

Job not on LinkedIn

🔥 4 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – 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.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 in identifying training and clinical compliance improvement opportunities • Facilitate audit reviews, reporting processes, and compliance committee activities • Analyze audit results and clinical data to identify trends, root causes, and improvement opportunities • 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 • 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 • Preferred: minimum of 2 years of clinical compliance auditing or healthcare auditing experience • Ability to provide an internet connection with at least 100 Mbps download and 10 Mbps upload • Ability to be accessible during stated working hours and participate in virtual meetings with camera on • Must follow security policies and procedures to protect PHI, PII, and Guidehealth intellectual property

🏖️ Benefits

• Fully remote work with work-from-home flexibility • Medical, dental, and vision plans • 401(k) plan with a 3% employer match to a 6% employee contribution • Life and disability insurance • Voluntary life insurance options • Employee Assistance Program (EAP) • Paid time off plans • Paid parental leave • Learning and development resources • Necessary work equipment provided at no charge • Equal opportunity employment