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Guide Healthcare
Guide Healthcare
51 – 200 Angajați
Asigurare de sănătateAsistență medicalăRecrutare
Guide Healthcare activează în domeniul serviciilor de sănătate conexe și al recrutării în sectorul medical, punând accent pe sprijinirea și tratarea persoanelor vârstnice. Înființată în 2018, compania colaborează cu clienți, parteneri și echipe pentru a oferi valoare practică în sectorul sănătății, adoptând o abordare diferită în furnizarea serviciilor și recrutare. Activitatea sa poate fi relevantă pentru profesioniști interesați de asistență medicală, servicii de sănătate conexe, recrutare și servicii pentru persoane vârstnice.
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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.

USStatele Unite ale AmericiiTXTexas
82.000 $ – 87.000 $ / an
RemoteNormă întreagăNivel mediuSeniorLimbă Obligatorie: englezăAuditor

Descriere

  • 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.

Cerințe

  • 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.

Beneficii

  • 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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