Registered Nurse – Clinical Compliance Auditor
Guide Healthcare
Posted: 10/22/2026
Medicaid Auditor
Integrity Management Services, Inc.
Posted: 10/22/2026Registered Nurse, Clinical Compliance Auditor
Guide Healthcare
Posted: 10/22/2026
Medicaid Fraud Auditor
Peraton
Posted: 10/21/2026Auditor – Medicaid
Peraton
Posted: 10/21/2026
Auditor II – Medicare Cost Reporting
BlueCross BlueShield of South Carolina
Posted: 10/21/2026
Senior IT Auditor
City National Bank of Florida
Posted: 10/21/2026Cyber SecurityFirewallsOracleSQLTableau
Senior Auditor – Banking Products
U.S. Bank
Posted: 10/21/2026
Auditor II – Medicare Cost Reporting
Palmetto GBA
Posted: 10/21/2026
Medical Review Nurse – Commercial DME Auditor
Machinify
Posted: 10/21/2026
Claims Auditor
Delta Health Systems
Posted: 10/21/2026
Senior Auditor, Appeals
Cotiviti
Posted: 10/21/2026Senior Auditor – Compliance
U.S. Bank
Posted: 10/21/2026
Data Quality Auditor
CVS Health
Posted: 10/21/2026
Provider Coding Auditor – Educator
Munson Healthcare
Posted: 10/21/2026
Manager, Quality System Compliance Auditor
RTX
Posted: 10/21/2026
Internal Audit & Controls Auditor
TechnipFMC
Posted: 10/21/2026ERP
Charge Auditor, Payor Relations
Affordable Dentures & Implants
Posted: 10/21/2026
Aggregate Claims Auditor
Brown & Brown Insurance
Posted: 10/21/2026
SA 8000 Certification Auditor – 1099
American Bureau of Shipping (ABS)
Posted: 10/21/2026Registered Nurse – Clinical Compliance Auditor
Guide HealthcarePosted 10/22/2026full-timeRemote • Texas • United StatesMid-LevelSenior💰 $82,000 - $87,000 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical compliance auditing, utilization management processes, and regulatory compliance requirements, with a strong ability to analyze data and present findings to leadership. Proficient in developing compliance procedures and mentoring clinical operations staff to enhance compliance infrastructure.
Highest-signal resume keywords
Registered Nurse (RN) LicenseUtilization Management ProcessesClinical Compliance AuditingRegulatory Compliance RequirementsMicrosoft Office Proficiency
About the role
Key responsibilities & impact- Conduct comprehensive clinical compliance audits covering utilization management, denial documentation, clinical reporting, authorization compliance, and delegated services
- Monitor adherence to UM and PHM Plans, Managed Services Agreements, and client-specific contractual and regulatory requirements
- Perform routine, scheduled, and ad hoc audits
- Serve as a secondary reviewer for denial documentation
- Monitor audit findings to identify trends, risks, and improvement opportunities
- Monitor clinical workflows and reporting processes for compliance risks, documentation deficiencies, and process gaps
- Assist with audit tools, audit protocols, and compliance monitoring frameworks
- Assist with development and maintenance of UM and PHM Plans and clinical compliance procedures
- Provide mentorship, guidance, and subject matter expertise to Clinical Compliance Auditors and clinical operations staff
- Support leadership in identifying training needs and clinical compliance improvement opportunities
- Assist with audit reviews, reporting processes, and compliance committee support activities
- Analyze audit results and clinical data to identify trends, root causes, and improvement opportunities
- Prepare and present audit findings and compliance reports to clinical leadership and operational stakeholders
- Support development of reporting tools, dashboards, and audit metrics
- Collaborate with Clinical Leadership, Compliance, and Operations teams to identify risks and support regulatory readiness
- Exercise independent judgment to evaluate compliance risks and strengthen clinical compliance infrastructure
- Adapt to evolving business needs and support cross-functional initiatives
Requirements
What you’ll need- Active, unrestricted Registered Nurse (RN) license required
- Strong knowledge of utilization management processes, clinical documentation, and regulatory compliance requirements
- Minimum of 3–5 years of experience in utilization management, clinical auditing, clinical compliance, or managed care
- Knowledge of Medicare, Commercial Managed Care, and delegated services compliance requirements
- Ability to work independently and exercise sound professional judgment
- Proficiency with Microsoft Office, including Excel, Word, and reporting tools
- Minimum of 2 years of clinical compliance auditing or healthcare auditing experience preferred as an additional qualification
- Ability to provide own internet connection capable of video calls and internal/external systems
- Minimum internet speed of 100 Mbps download and 10 Mbps upload
- Must be accessible during stated working hours
- Must join virtual meetings with cameras on
- Must follow security policies and procedures protecting PHI, PII, and company intellectual property
Benefits
Comp & perks- Fully remote work arrangement
- Necessary work equipment provided at no charge
- Medical, Dental, and Vision plans
- 401(k) plan with a 3% employer match to 6% employee contribution
- 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 30 or more hours per week are eligible for comprehensive benefits
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Compliance AuditingUtilization ManagementClinical DocumentationAudit ToolsReporting ProcessesData AnalysisCompliance Monitoring FrameworksAudit ProtocolsTrend IdentificationRisk Assessment
Soft Skills
Independent JudgmentMentorshipCollaborationCommunicationAdaptability
Tools & Technologies
Microsoft ExcelMicrosoft WordReporting ToolsDashboardsAudit Metrics
Certifications & Qualifications
Registered Nurse (RN) License
Industry Keywords
Medicare ComplianceCommercial Managed CareDelegated Services ComplianceClinical WorkflowsPHI ProtectionPII Protection