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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 - Texas Remote

Clinical Compliance Auditor II responsible for auditing utilization management and clinical operations at Guidehealth, a data-powered value-based healthcare company. This remote role supports regulatory, contractual, and clinical 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 requirements.
  • Track compliance with UM and PHM Plans, Managed Services Agreements, and client-specific contractual and regulatory standards.
  • Complete routine, scheduled, and ad hoc audits.
  • Act as a secondary reviewer for denial documentation.
  • Review 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 Clinical Compliance Auditors and clinical operations staff while providing subject matter expertise.
  • Help leadership assess training needs and opportunities to improve clinical compliance.
  • Coordinate audit reviews, reporting activities, and compliance committee support.
  • Evaluate audit results and clinical data to uncover trends and root causes.
  • Prepare and present audit findings and compliance reports for clinical leaders and operational stakeholders.
  • Assist with developing reporting tools, dashboards, and audit metrics.
  • Respond to changing business needs and contribute to cross-functional initiatives.

Requirements

  • Hold an active, unrestricted Registered Nurse (RN) license.
  • Demonstrate strong knowledge of utilization management, clinical documentation, and regulatory compliance.
  • Bring 3–5 years of experience in utilization management, clinical auditing, clinical compliance, or managed care.
  • Understand Medicare, commercial managed care, and delegated-services compliance requirements.
  • Work independently and apply sound professional judgment.
  • Use Microsoft Office proficiently, including Excel, Word, and reporting tools.
  • Have at least 2 years of clinical compliance or healthcare auditing experience preferred.
  • Maintain an internet connection with at least 100 Mbps download and 10 Mbps upload speeds.
  • Remain accessible during stated working hours.
  • Follow security policies and procedures protecting PHI, PII, and company intellectual property.

Benefits

  • Work fully remotely.
  • Receive necessary work equipment at no cost.
  • Access comprehensive medical, dental, and vision plans.
  • Participate in a 401(k) plan with a 3% employer match to a 6% employee contribution.
  • Receive life and disability insurance.
  • Access voluntary life insurance options.
  • Use the Employee Assistance Program (EAP).
  • Receive paid time off.
  • Take paid parental leave.
  • Access learning and development resources.
  • Use a flexible work arrangement.
  • Provide your own internet connection meeting the minimum requirement of 100 Mbps download and 10 Mbps upload.

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