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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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Locurile de muncă ale companiei

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.

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

Descriere

  • 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.

Cerințe

  • 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.

Beneficii

  • 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.

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