Remote Clinical Auditor Jobs
Remote clinical auditor jobs are open across the U.S. at remote-first firms, distributed healthcare organizations, and managed care companies building out compliance teams without geographic limits. Employers hiring remotely right now include Guidehealth, PACS, and CorVel Corporation. See the openings below and apply to the ones that match your experience.
Find Remote Clinical Auditor JobsOverview
Showing 5 of 13+ Remote Clinical Auditor jobs
Your Role
The Delegation Oversight Compliance team is responsible for working with appropriate departments in the areas of compliance, process improvement, and member/provider satisfaction for all product lines. Reviews, research and responds to customer complaints relating to quality of medical care and service. Recommend and/or implement process improvements related to the potential quality of medical care and service. The Delegation Oversight Clinical Nurse Auditor – LVN, Senior, will report to the Delegations Oversight Compliance Manager.
The Clinical Nurse Auditor - LVN, Senior is responsible for independently conducting comprehensive delegation oversight audits to evaluate delegated entities’ compliance with the California Department of Managed Health Care (DMHC) All Plan Letter (APL) 24-019, Rule 1300.67.2.2. The position conducts regulatory compliance assessments of delegated medical groups, Independent Practice Associations (IPAs), Management Services Organizations (MSOs), and other contracted entities to ensure the accuracy, completeness, and reliability of information provided to the health plan for regulatory oversight.
As a senior-level auditor, this position independently manages complex audit assignments, evaluates regulatory risks, develops audit findings, monitors corrective actions, and provides technical guidance to delegated entities. The position supports the organization’s regulatory readiness and accountability for delegated functions.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Work
In this role, you will:
- Oversee delegated groups and vendors’ policies, procedures, utilization management, and related activities.
- Monitor compliance with APL 25-019 out-of-network provider access requirements, including Letters of Agreement (LOAs), Memoranda of Understanding (MOUs), and concierge services. Perform on-site and virtual audits.
- Independently plan, coordinate, and perform annual, focused, and for-cause audits to assess delegated entities’ compliance with applicable APL 24-019 requirements.
- Assess delegated policies, procedures, workflows, and internal controls that support Annual Network Reporting.
- Substantiate compliance findings through document reviews, data validation, sampling, and interviews.
- Detect regulatory deficiencies, operational gaps, and systemic compliance risks.
- Document clear, accurate audit findings supported by evidence.
- Link each deficiency to the applicable regulatory, contractual, or organizational requirement.
- Review delegated entities’ corrective action plans.
- Assess root-cause analyses and proposed corrective actions.
- Track corrective action implementation and completion deadlines.
- Referring recurring findings, unresolved deficiencies, and material regulatory risks to management for escalation.
- Keep audit and corrective action records complete and accurate.
- Produce audit reports detailing findings, supporting evidence, regulatory references, and required corrective actions.
- Examine delegated groups’ reports to verify compliance with specific regulations.
- Partner with Blue Shield staff on regulatory audits, corrective action plans, and regulatory agency enforcement actions.
- Provide medical groups/IPAs with education on changes to regulatory requirements and/or accreditation standards.
- Familiarity with DMHC APL 24-019, Rule 1300.67.2.2, and Annual Network Reporting requirements is preferred.
- Understand auditing practices for delegated medical groups, IPAs, or MSOs.
- Pursue operational targets that directly affect departmental results.
- Operate independently with limited supervision.
- Work is reviewed to determine whether it meets objectives.
- May assume full responsibility for projects or processes within the role’s scope.
- Perform additional duties as assigned
Your Knowledge and Experience
- High School Diploma/GED and completion of a state-approved Vocational Nursing (LVN) program
- Current unrestricted CA LVN License
- 5 years of prior relevant experience Strong critical thinking, analytical, and problem-solving skills
-
Hybrid
This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
ABOUT THE TEAM
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!
Our Values:
- Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
For most teams, this means coming into the office two days per week.
Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
Your Role
The Delegation Oversight Compliance team is responsible for working with appropriate departments in the areas of compliance, process improvement, and member/provider satisfaction for all product lines. Reviews, research and responds to customer complaints relating to quality of medical care and service. Recommend and/or implement process improvements related to the potential quality of medical care and service. The Delegation Oversight Clinical Nurse Auditor – LVN, Senior, will report to the Delegations Oversight Compliance Manager.
The Clinical Nurse Auditor - LVN, Senior is responsible for independently conducting comprehensive delegation oversight audits to evaluate delegated entities’ compliance with the California Department of Managed Health Care (DMHC) All Plan Letter (APL) 24-019, Rule 1300.67.2.2. The position conducts regulatory compliance assessments of delegated medical groups, Independent Practice Associations (IPAs), Management Services Organizations (MSOs), and other contracted entities to ensure the accuracy, completeness, and reliability of information provided to the health plan for regulatory oversight.
As a senior-level auditor, this position independently manages complex audit assignments, evaluates regulatory risks, develops audit findings, monitors corrective actions, and provides technical guidance to delegated entities. The position supports the organization’s regulatory readiness and accountability for delegated functions.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Work
In this role, you will:
- Oversee delegated groups and vendors’ policies, procedures, utilization management, and related activities.
- Monitor compliance with APL 25-019 out-of-network provider access requirements, including Letters of Agreement (LOAs), Memoranda of Understanding (MOUs), and concierge services. Perform on-site and virtual audits.
- Independently plan, coordinate, and perform annual, focused, and for-cause audits to assess delegated entities’ compliance with applicable APL 24-019 requirements.
- Assess delegated policies, procedures, workflows, and internal controls that support Annual Network Reporting.
- Substantiate compliance findings through document reviews, data validation, sampling, and interviews.
- Detect regulatory deficiencies, operational gaps, and systemic compliance risks.
- Document clear, accurate audit findings supported by evidence.
- Link each deficiency to the applicable regulatory, contractual, or organizational requirement.
- Review delegated entities’ corrective action plans.
- Assess root-cause analyses and proposed corrective actions.
- Track corrective action implementation and completion deadlines.
- Referring recurring findings, unresolved deficiencies, and material regulatory risks to management for escalation.
- Keep audit and corrective action records complete and accurate.
- Produce audit reports detailing findings, supporting evidence, regulatory references, and required corrective actions.
- Examine delegated groups’ reports to verify compliance with specific regulations.
- Partner with Blue Shield staff on regulatory audits, corrective action plans, and regulatory agency enforcement actions.
- Provide medical groups/IPAs with education on changes to regulatory requirements and/or accreditation standards.
- Familiarity with DMHC APL 24-019, Rule 1300.67.2.2, and Annual Network Reporting requirements is preferred.
- Understand auditing practices for delegated medical groups, IPAs, or MSOs.
- Pursue operational targets that directly affect departmental results.
- Operate independently with limited supervision.
- Work is reviewed to determine whether it meets objectives.
- May assume full responsibility for projects or processes within the role’s scope.
- Perform additional duties as assigned
Your Knowledge and Experience
- High School Diploma/GED and completion of a state-approved Vocational Nursing (LVN) program
- Current unrestricted CA LVN License
- 5 years of prior relevant experience Strong critical thinking, analytical, and problem-solving skills
-
Hybrid
This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
ABOUT THE TEAM
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!
Our Values:
- Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
For most teams, this means coming into the office two days per week.
Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
See All 13 Remote Clinical Auditor Jobs
Find roles that match your experience and apply in just a few clicks.
Find Remote Clinical Auditor JobsRemote Clinical Auditor Job Market
Who's Hiring
Top Industries Hiring
- Technology & Software
What Employers Look For
The qualifications that appear most often in remote clinical auditor jobs.
- Knowledge of ICD-10-CM/PCS coding guidelines and clinical documentation standards
- Experience conducting medical record audits in an acute care or managed care setting
- Certification such as CPC, RHIA, RHIT, or CCS from a recognized credentialing body
- Proficiency with electronic health record systems such as Epic, Cerner, or Meditech
- Familiarity with CMS regulations, RAC audit processes, and payer-specific requirements
- Strong written communication skills for producing clear, actionable audit reports
Tips for Your Remote Clinical Auditor Job Search
Apply early to remote roles that fit
Migrate Mate lists remote clinical auditor openings from across the U.S. in one place, so you can find roles that match your background and apply directly without sorting through unrelated listings.
Prove your async communication skills upfront
Remote clinical audit work is almost entirely written. Tailor your cover letter to show you can produce clear, precise audit findings documentation without back-and-forth clarification. Concrete examples of written reports you have delivered independently carry more weight than generic claims about communication skills.
Highlight your EHR and audit platform proficiency
Remote clinical auditor hiring managers want to know you can work inside their existing tech stack from day one. Name the specific EHR systems, audit management tools, and coding platforms you have used, and describe how you used them to complete reviews without on-site IT support.
Prepare for a remote-first interview format
Most remote clinical auditor interviews involve a written or structured skills assessment in addition to a video call. Practice walking through your audit methodology clearly on camera, and be ready to explain how you manage your review queue, flag discrepancies, and meet deadlines when working independently across time zones.
Remote Clinical Auditor Jobs: Frequently Asked Questions
How do I get a remote clinical auditor job?
Focus on companies with distributed compliance teams, remote-first health plans, and third-party review organizations that have moved audit workflows entirely online. Remote employers screen for self-direction, clear written communication, and comfort with electronic health record systems and audit management platforms. Demonstrating experience completing audits independently, meeting deadlines without on-site supervision, and documenting findings in precise written reports gives you a clear edge over candidates who have only worked in centralized office environments.
Which companies hire remote clinical auditors?
Remote clinical auditor roles are posted by Guidehealth, PACS, and CorVel Corporation and others right now, based on current remote listings on Migrate Mate as of November 2026. The employers hiring most consistently are remote-first health plans, managed care organizations, and third-party clinical review firms that run distributed audit teams across multiple states.
Can you get a remote clinical auditor job with no experience?
Yes, but remote entry-level clinical auditor roles are harder to land because employers expect you to work independently from day one with minimal on-site mentorship. Your best paths in are through remote-first utilization review firms and smaller compliance contractors that hire junior auditors. Showing completed coursework in medical coding or clinical documentation, a strong grasp of audit tools, and any freelance or volunteer review work helps close the experience gap.
Do you need a degree for remote clinical auditor jobs?
Not always. Many remote employers value clinical credentials, hands-on audit experience, and demonstrated proficiency with EHR platforms and coding standards as much as a formal degree. A clinical background in nursing, health information management, or medical coding combined with certifications like CPC or RHIT can satisfy requirements at a wide range of remote employers, particularly third-party review organizations and remote-first managed care contractors.
Which industries hire the most remote clinical auditors?
The sectors hiring the most remote clinical auditors are Technology & Software, based on current remote listings on Migrate Mate as of November 2026. These sectors rely on distributed audit teams because their compliance and quality review workflows are documentation-driven and can be completed fully through secure remote access to electronic records.
See All 13 Remote Clinical Auditor Jobs
Find roles that match your experience and apply in just a few clicks.
Find Remote Clinical Auditor Jobs