
Registered Nurse Clinical Compliance Auditor
Guide HealthcareAudit utilization management and clinical compliance for Guidehealth, a data-powered value-based healthcare company. Review documentation, regulatory adherence, and delegated services.


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

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

Audit Medicaid managed care plans and providers for Integrity Management Services, a government compliance and program integrity firm. Identify fraud, waste, abuse, and improper payments.

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.

Review medical records and ICD codes for CVS Health’s risk adjustment programs. Support accurate clinical documentation, coding, and regulatory compliance.

Review aggregate stop-loss claims, contract eligibility, funding, and attachment points for Brown & Brown customers. Prepare audit reports and address third-party administrator appeals in this remote role.