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Guide Healthcare
Guide Healthcare
51 – 200 Darbinieki
Personāla atlaseVeselības apdrošināšanaVeselības aprūpe
Guide Healthcare darbojas radniecīgo veselības aprūpes pakalpojumu un veselības aprūpes personāla atlases jomā, īpašu uzmanību pievēršot vecāka gadagājuma cilvēku atbalstam un ārstēšanai. Uzņēmums, kas dibināts 2018. gadā, sadarbojas ar klientiem, partneriem un komandām, lai veselības aprūpes nozarē radītu praktisku vērtību, kā arī pakalpojumu sniegšanai un personāla atlasei pieiet citādi. Tā darbība var būt saistoša speciālistiem, kurus interesē veselības aprūpe, radniecīgās veselības aprūpes jomas, personāla atlase un pakalpojumi vecāka gadagājuma cilvēkiem.
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Vakances uzņēmumā

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.

USAmerikas Savienotās ValstisTXTeksasa
82 000 $ – 87 000 $ / gads
AttālinātiPilna slodzeVidējais līmenisVecākais speciālistsNepieciešamā Valoda: angļuRevidents

Apraksts

  • 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.

Prasības

  • 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.

Priekšrocības

  • 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.

Saistītās vakances

BlueCross BlueShield of South Carolina

Auditor II, Medicare Cost Reporting

BlueCross BlueShield of South Carolina
Juridiskie pakalpojumiKonsultācijasVeselības aprūpe
USAmerikas Savienotās ValstisALAlabamaAKAļaskaAZArizonaCAKalifornijaCOKolorādoCTKonektikutaFLFloridaHIHavajasIDAidahoILIlinoisaIAAiovaKSKanzasaKYKentukiLALuiziānaMEMeinaMDMerilendaMAMasačūsetsaMIMičiganaMNMinesotaMSMisisipiMOMisūriMTMontānaNENebraskaNVNevadaNHŅūhempšīraNJŅūdžersijaNMŅūmeksikaNYŅujorkaNCZiemeļkarolīnaNDZiemeļdakotaOHOhaioOKOklahomaOROregonaPAPensilvānijaRIRodailendaSCDienvidkarolīnaSDDienviddakotaTNTenesīTXTeksasaUTJūtaVTVērmontaVAVirdžīnijaWAVašingtonaWIViskonsinaWYVaiominga
49 447 $ – 94 737 $ / gads
AttālinātiPilna slodzeVidējais līmenisVecākais speciālistsNepieciešamā Valoda: angļuRevidents

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.

Atvērt
Cotiviti

Senior Appeals Auditor – Cotiviti (Remote, US)

Cotiviti
5001 – 10 000 Darbinieki
H1B vīzas sponsorsKonsultācijasLoģistikaVeselības aprūpe
USAmerikas Savienotās Valstis
47 $ – 57 $ / stunda
AttālinātiPilna slodzeVecākais speciālistsNepieciešamā Valoda: angļuRevidents

Defend Cotiviti’s recovery decisions by reviewing Medicare claims, clinical records, coding, medical necessity, and provider appeals. Prepare evidence-based appeal responses and support cases progressing to Administrative Law Judge hearings.

Atvērt