Supervisor, Clinical Compliance (RN) - Remote

About the role

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.

Responsibilities

• Supervising and directing the day-to-day operations of the clinical compliance auditors and specialists.
• Serving as the clinical services liaison to senior management and other company leaders and assisting in developing coordinated and efficient companywide team processes.
• Assisting with coordinating orientation, training, continuing education, and ongoing performance monitoring for clinical compliance auditors and other departments as required.
• Working with Leadership to promote staff members’ continued professional growth and education.
• In conjunction with the Compliance Manager, UM Manager, and PHM Manager, overseeing and assisting with developing and managing the agenda and meeting minutes for the monthly utilization management data reported to the Independent Physician Association (IPA) UM Committee.
• Assisting with facilitating UM and PHM Plan development and adherence.
• Identifying UM and PHM Plan requirements and assisting in creating auditing guidelines to ensure clinical staff continue to meet minimum requirements, including quarterly, semiannual, and annual submission requirements set forth in the UM and PHM Plans.
• Serving as a secondary reviewer to ensure adherence to the denial process and all denial compliance audit requirements, reviewing documentation, and ensuring all documentation is submitted in a timely manner.
• Supporting the maintenance of confidentiality related to all computer programs, medical records, and other data.
• Providing critical-thinking skills, decisive judgment, and the ability to work with minimal supervision.
• Ensuring meeting minutes are completed, signed, and uploaded in accordance with UM and PHM Plan requirements.
• Assisting with all internal and external audit reviews and submissions.
• Completing monthly check-ins with clinical compliance auditors and specialists.

Qualifications

• Certified/Registered Medical Assistant (CMA/RMA) or equivalent clinical background.
• 3+ years of experience as a Medical Assistant, including patient outreach or care coordination.
• 1+ years of experience in a supervisory or leadership role, preferably in a remote setting.
• Strong understanding of SDOH and barriers to healthcare access.
• High emotional intelligence (EQ) with excellent communication, coaching, and conflict-resolution skills.
• Ability to thrive in a fast-paced, high-touch environment with shifting priorities.
• Proficiency in electronic health records (EHRs), telehealth platforms, and data tracking tools.

Benefits

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Medical, Dental, and Vision plans to keep you covered.
• 401(k) plan with a 3% employer match to your 6% contribution.
• Life and Disability insurance for those "just in case" moments.
• Employee Assistance Program (EAP) to help you through tough times.
• Paid time off plans to help you achieve work-life balance and meet your personal goals.
• Paid parental leave to give you the time you need.
• Variety of resources dedicated to your learning and development to advance your career with us.

Compensation

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

Secondary Employment

We kindly ask all team members to disclose any secondary employment, regardless of whether it may present a potential conflict of interest. To ensure smooth teamwork and availability, employees must be accessible during our stated working hours. We foster connection and engagement by asking team members to join virtual meetings with their cameras on.