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Guide Healthcare
Guide Healthcare
51 – 200 कर्मचारी
भर्तीस्वास्थ्य बीमास्वास्थ्य सेवा
Guide Healthcare संबद्ध स्वास्थ्य सेवाओं और स्वास्थ्य सेवा भर्ती के क्षेत्र में काम करती है, और इसका ध्यान वृद्ध वयस्कों की सहायता और उपचार पर है। 2018 में स्थापित यह कंपनी स्वास्थ्य सेवा क्षेत्र में व्यावहारिक मूल्य प्रदान करने के लिए ग्राहकों, साझेदारों और टीमों के साथ काम करती है तथा सेवा प्रदान करने और भर्ती के लिए एक अलग दृष्टिकोण अपनाती है। इसका कार्य स्वास्थ्य सेवा, संबद्ध स्वास्थ्य, भर्ती और वृद्ध लोगों के लिए सेवाओं में रुचि रखने वाले पेशेवरों के लिए प्रासंगिक हो सकता है।
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कंपनी की नौकरियाँ

Registered Nurse Clinical Compliance Auditor

Audit utilization management, delegated services, and clinical compliance for Guidehealth’s value-based healthcare operations. This remote role supports regulatory readiness and clinical quality.

USसंयुक्त राज्यTXटेक्सास
$82,000 – $87,000 / वर्ष
रिमोटपूर्णकालिकमध्य स्तरवरिष्ठआवश्यक भाषा: अंग्रेज़ीलेखा परीक्षक

विवरण

  • Conduct clinical compliance audits of utilization management, denial documentation, clinical reporting, authorization compliance, and delegated services.
  • Check compliance with UM and PHM Plans, Managed Services Agreements, and client contractual and regulatory requirements.
  • Carry out routine, scheduled, and ad hoc audits.
  • Review denial documentation as a secondary reviewer.
  • Track audit results to spot trends, risks, and opportunities to improve.
  • Check clinical workflows and reporting for compliance risks, documentation gaps, and process deficiencies.
  • Help maintain audit tools, protocols, and compliance monitoring frameworks.
  • Help develop and maintain UM and PHM Plans and clinical compliance procedures.
  • Mentor and advise Clinical Compliance Auditors and clinical operations staff.
  • Help leadership identify training needs and opportunities to improve clinical compliance.
  • Assist with audit reviews, reporting, and compliance committee activities.
  • Analyze audit results and clinical data to identify trends, root causes, and improvement opportunities.
  • Present audit findings and compliance reports to clinical leaders and operational stakeholders.
  • Help develop reporting tools, dashboards, and audit metrics.
  • Work with Clinical Leadership, Compliance, and Operations teams to identify risks and support regulatory readiness.
  • Use independent judgment to assess compliance risks and strengthen clinical compliance processes.
  • Adapt to changing business needs and contribute to cross-functional initiatives.

आवश्यकताएँ

  • Hold an active, unrestricted Registered Nurse (RN) license.
  • Know utilization management processes, clinical documentation, and regulatory compliance requirements.
  • Have 3–5 years of experience in utilization management, clinical auditing, clinical compliance, or managed care.
  • Know Medicare, commercial managed care, and delegated services compliance requirements.
  • Work independently and apply sound professional judgment.
  • Use Microsoft Office, including Excel, Word, and reporting tools.
  • Preferred: at least 2 years of clinical compliance auditing or healthcare auditing experience.
  • Provide an internet connection suitable for video calls and internal and external systems.
  • Have internet speeds of at least 100 Mbps download and 10 Mbps upload.
  • Be available during stated working hours.
  • Join virtual meetings with the camera on.
  • Follow security policies and procedures for protecting PHI, PII, and company intellectual property.

लाभ

  • Fully remote work arrangement.
  • Necessary work equipment provided at no cost.
  • Medical, dental, and vision plans.
  • 401(k) plan with a 3% employer match when the employee contributes 6%.
  • Life and disability insurance.
  • Voluntary life insurance options.
  • Employee Assistance Program (EAP).
  • Paid time off plans.
  • Paid parental leave.
  • Learning and development resources.
  • Flexible work-from-home arrangement.
  • Employees working at least 30 hours per week qualify for comprehensive benefits.

संबंधित नौकरियाँ

BlueCross BlueShield of South Carolina

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