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Guide Healthcare
Guide Healthcare
51 – 200 Employees
HealthcareHealthcare InsuranceRecruitment
Guide Healthcare operates across allied health services and healthcare recruitment, with a focus on supporting and treating older adults. Established in 2018, the company works with clients, partners, and teams to deliver practical value in the healthcare sector while taking a different approach to service provision and recruitment. Its work may be relevant to professionals interested in healthcare, allied health, recruitment, and services for older people.
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Clinical Compliance Auditor II (Remote)

Guidehealth is seeking a Clinical Compliance Auditor II to review utilization management and clinical operations. This remote role focuses on regulatory, contractual, and patient-care compliance.

USUnited StatesTXTexas
$82,000 – $87,000 / year
RemoteFull-timeMiddleSeniorEnglish RequiredAuditor

Description

  • Lead comprehensive clinical compliance audits across utilization management, denial documentation, clinical reporting, authorization compliance, and delegated services.
  • Track compliance with UM and PHM Plans, Managed Services Agreements, and client-specific contractual and regulatory standards.
  • Complete routine, scheduled, and as-needed audits.
  • Act as a secondary reviewer for denial documentation.
  • Review audit findings, clinical workflows, and reporting processes to surface trends, risks, documentation weaknesses, and process gaps.
  • Create and maintain audit tools, protocols, compliance monitoring frameworks, UM and PHM Plans, and clinical compliance procedures.
  • Mentor Clinical Compliance Auditors and clinical operations staff through guidance and subject matter expertise.
  • Help leadership assess training requirements and opportunities to strengthen clinical compliance.
  • Coordinate audit reviews, reporting activities, and support for compliance committees.
  • Evaluate audit results and clinical data to identify trends, root causes, and areas for improvement.
  • Present audit findings and compliance reports to clinical leaders and operational stakeholders.
  • Contribute to reporting tools, dashboards, and audit metrics.
  • Respond to changing business priorities and participate in cross-functional initiatives.
  • Follow security policies and procedures to safeguard PHI, PII, and Guidehealth intellectual property.

Requirements

  • Hold an active, unrestricted Registered Nurse (RN) license.
  • Bring 3–5 years of experience in utilization management, clinical auditing, clinical compliance, or managed care.
  • Have at least 2 years of experience in clinical compliance or healthcare auditing.
  • Demonstrate strong knowledge of utilization management, clinical documentation, and regulatory compliance.
  • Understand compliance requirements for Medicare, commercial managed care, and delegated services.
  • Apply strong analytical, critical-thinking, and problem-solving skills.
  • Work independently and exercise sound professional judgment.
  • Communicate effectively in writing and verbally.
  • Use Microsoft Office proficiently, including Excel, Word, and reporting tools.
  • Provide a personal internet connection with at least 100 Mbps download and 10 Mbps upload speeds.
  • Remain available during the stated working hours.
  • Be willing to attend virtual meetings with cameras enabled.

Benefits

  • Work fully remotely.
  • Receive necessary work equipment at no cost.
  • Access Medical, Dental, and Vision plans.
  • Participate in a 401(k) plan with a 3% employer match on contributions up to 6%.
  • Access Life and Disability insurance.
  • Choose from Voluntary Life insurance options.
  • Use the Employee Assistance Program (EAP).
  • Access paid time off plans.
  • Receive paid parental leave.
  • Use learning and development resources.
  • Maintain a flexible work-life balance.
  • Receive a comprehensive benefits package if eligible as a full-time employee working 30 or more hours per week.

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