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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 and clinical compliance for Guidehealth, a data-powered value-based healthcare company. Review documentation, regulatory adherence, and delegated services.

USसंयुक्त राज्यPAपेंसिल्वेनिया
$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.
  • Provide secondary review of denial documentation.
  • Track audit findings, clinical workflows, and reporting processes to identify trends, risks, documentation deficiencies, and process gaps.
  • Create and maintain audit tools, protocols, compliance monitoring frameworks, UM and PHM Plans, and clinical compliance procedures.
  • Mentor and advise Clinical Compliance Auditors and clinical operations staff, sharing subject matter expertise.
  • Help leadership identify training needs and opportunities to improve clinical compliance.
  • Coordinate audit reviews, reporting, and compliance committee activities.
  • Analyze audit results and clinical data to find trends, root causes, and opportunities for improvement.
  • Present audit findings and compliance reports to clinical leaders and operational stakeholders.
  • Help develop reporting tools, dashboards, and audit metrics.
  • Adjust 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 exercise sound professional judgment.
  • Use Microsoft Office, including Excel, Word, and reporting tools proficiently.
  • Preferred: at least 2 years of clinical compliance or healthcare auditing experience.
  • Provide an internet connection with at least 100 Mbps download and 10 Mbps upload speeds.
  • Be available during stated working hours and attend virtual meetings with the camera on.
  • Follow security policies and procedures to protect PHI, PII, and Guidehealth intellectual property.

लाभ

  • Fully remote work with work-from-home flexibility.
  • Medical, dental, and vision plans.
  • 401(k) plan with a 3% employer match when employees contribute 6%.
  • Life and disability insurance.
  • Optional life insurance coverage.
  • Employee Assistance Program (EAP).
  • Paid time off plans.
  • Paid parental leave.
  • Learning and development resources.
  • Necessary work equipment provided at no cost.
  • Equal opportunity employment.

संबंधित नौकरियाँ

BlueCross BlueShield of South Carolina

Auditor II, Medicare Cost Reporting

BlueCross BlueShield of South Carolina
कानूनीपरामर्शस्वास्थ्य सेवा
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$49,447 – $94,737 / वर्ष
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Conducts financial, compliance, and operational audits for BlueCross Blue Shield of South Carolina, with a focus on Medicare cost reports. Evaluates controls and business risks, recommends corrective actions, and supports remote audits across the United States.

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Cotiviti
5,001 – 10,000 कर्मचारी
H1B वीज़ा प्रायोजकपरामर्शलॉजिस्टिक्सस्वास्थ्य सेवा
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FUJIFILM Corporation

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इलेक्ट्रॉनिक्सविनिर्माणस्वास्थ्य सेवा
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