Guide Healthcare ittifoqdosh tibbiy xizmatlar va sog‘liqni saqlash sohasida xodimlarni ishga jalb qilish yo‘nalishlarida faoliyat yuritadi hamda keksalarga ko‘maklashish va ularni davolashga e’tibor qaratadi. 2018-yilda tashkil etilgan kompaniya sog‘liqni saqlash sektorida amaliy qiymat yaratish uchun mijozlar, hamkorlar va jamoalar bilan ishlaydi, xizmat ko‘rsatish va ishga qabul qilish jarayonlariga o‘zgacha yondashuvni qo‘llaydi. Uning faoliyati sog‘liqni saqlash, ittifoqdosh tibbiy xizmatlar, ishga jalb qilish va keksalar uchun xizmatlarga qiziqadigan mutaxassislar uchun dolzarb bo‘lishi mumkin.
Clinical Compliance Auditor II (Remote)
Guidehealth is seeking a Clinical Compliance Auditor II to review utilization management and clinical operations. This remote role focuses on regulatory, contractual, and patient-care compliance.
Tavsif
- Lead comprehensive clinical compliance audits across utilization management, denial documentation, clinical reporting, authorization compliance, and delegated services.
- Track compliance with UM and PHM Plans, Managed Services Agreements, and client-specific contractual and regulatory standards.
- Complete routine, scheduled, and as-needed audits.
- Act as a secondary reviewer for denial documentation.
- Review audit findings, clinical workflows, and reporting processes to surface trends, risks, documentation weaknesses, 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 through guidance and subject matter expertise.
- Help leadership assess training requirements and opportunities to strengthen clinical compliance.
- Coordinate audit reviews, reporting activities, and support for compliance committees.
- Evaluate audit results and clinical data to identify trends, root causes, and areas for improvement.
- Present audit findings and compliance reports to clinical leaders and operational stakeholders.
- Contribute to reporting tools, dashboards, and audit metrics.
- Respond to changing business priorities and participate in cross-functional initiatives.
- Follow security policies and procedures to safeguard PHI, PII, and Guidehealth intellectual property.
Talablar
- Hold an active, unrestricted Registered Nurse (RN) license.
- Bring 3–5 years of experience in utilization management, clinical auditing, clinical compliance, or managed care.
- Have at least 2 years of experience in clinical compliance or healthcare auditing.
- Demonstrate strong knowledge of utilization management, clinical documentation, and regulatory compliance.
- Understand compliance requirements for Medicare, commercial managed care, and delegated services.
- Apply strong analytical, critical-thinking, and problem-solving skills.
- Work independently and exercise sound professional judgment.
- Communicate effectively in writing and verbally.
- Use Microsoft Office proficiently, including Excel, Word, and reporting tools.
- Provide a personal internet connection with at least 100 Mbps download and 10 Mbps upload speeds.
- Remain available during the stated working hours.
- Be willing to attend virtual meetings with cameras enabled.
Imtiyozlar
- Work fully remotely.
- Receive necessary work equipment at no cost.
- Access Medical, Dental, and Vision plans.
- Participate in a 401(k) plan with a 3% employer match on contributions up to 6%.
- Access Life and Disability insurance.
- Choose from Voluntary Life insurance options.
- Use the Employee Assistance Program (EAP).
- Access paid time off plans.
- Receive paid parental leave.
- Use learning and development resources.
- Maintain a flexible work-life balance.
- Receive a comprehensive benefits package if eligible as a full-time employee working 30 or more hours per week.