Registered Nurse, Clinical Compliance Auditor
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Guide HealthcarePosted 10/22/2026full-timeRemote • Pennsylvania • 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 identify improvement opportunities. Proficient in developing audit tools and providing mentorship to clinical operations staff.
Highest-signal resume keywords
Registered Nurse (RN) LicenseUtilization Management ProcessesClinical Compliance AuditingMicrosoft Office ProficiencyMedicare Compliance Knowledge
About the role
Key responsibilities & impact- Conduct comprehensive clinical compliance audits covering utilization management, denial documentation, clinical reporting, authorization compliance, and delegated services requirements
- 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, clinical workflows, and reporting processes to identify trends, risks, documentation deficiencies, and process gaps
- Develop and maintain audit tools, protocols, compliance monitoring frameworks, 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 and clinical compliance improvement opportunities
- Facilitate audit reviews, reporting processes, and compliance committee 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
- 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
- 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
- Preferred: minimum of 2 years of clinical compliance auditing or healthcare auditing experience
- Ability to provide an internet connection with at least 100 Mbps download and 10 Mbps upload
- Ability to be accessible during stated working hours and participate in virtual meetings with camera on
- Must follow security policies and procedures to protect PHI, PII, and Guidehealth intellectual property
Benefits
Comp & perks- Fully remote work with work-from-home flexibility
- Medical, dental, and vision plans
- 401(k) plan with a 3% employer match to a 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
- Necessary work equipment provided at no charge
- Equal opportunity employment
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 DocumentationRegulatory ComplianceAudit Tools DevelopmentData AnalysisReporting ProcessesTrend IdentificationProcess ImprovementClinical Workflow Monitoring
Soft Skills
MentorshipProfessional JudgmentIndependent WorkCommunicationCollaboration
Tools & Technologies
Microsoft ExcelMicrosoft WordReporting ToolsDashboardsAudit Metrics
Certifications & Qualifications
Registered Nurse (RN) License
Industry Keywords
Clinical ComplianceManaged CareMedicareCommercial Managed CareDelegated Services CompliancePHI ProtectionPII Protection