Clinical Quality Auditor, CO

What We Strive For At Strive Health, we’re driven by a purpose: transforming the broken kidney care system. Through early identification, engagement, and comprehensive coordinated care, we significantly improve outcomes for people with kidney disease, reducing emergency dialysis and inpatient utilization. Our high-touch care model integrates with local providers and uses predictive data to identify and support at-risk patients along their entire care journey. We embrace diversity, celebrate successes, and support each other, making Strive the destination for top talent in healthcare. Join us in making a real difference. Benefits & Perks

• Hybrid-Remote Flexibility – Work from home while fulfilling in-person needs at the office, clinic, or patient home visits.
• Comprehensive Benefits – Medical, dental, and vision insurance, employee assistance programs, employer-paid and voluntary life and disability insurance, plus health and flexible spending accounts.
• Financial & Retirement Support – Competitive compensation with a performance-based discretionary bonus program, 401k with employer match, and financial wellness resources.
• Time Off & Leave – Paid holidays, flexible vacation time, sick time, and paid birthgiving, bonding, sabbatical, and living donor leaves.
• Wellness & Growth – Family forming services through Maven Maternity at no cost and physical wellness perks, mental health support, and an annual professional development stipend.

What You’ll Do As the Clinical Quality Auditor, you will be responsible for completing quality review processes for care management programs. This role is responsible for ensuring appropriate clinical and care delivery practices are utilized and case documentation meets established standards consistently to support meeting internal and external quality standards, compliance, and expectations. As an auditor, you will utilize clinical experience, expertise, and quality guidelines to review patient files, care plans and interactions and care plans against appropriate applicable quality criteria in conjunction with program, accreditation and industry requirements. You will support various Kidney Hero roles (clinical and non-clinical) regarding case auditing, outcomes and coaching, quality improvement strategies, resource development and other activities to promote continuous quality improvement. This quality improvement support will be provided to operational managers and leadership to communicate and facilitate resolution for quality risks, such as root cause analysis and remediation recommendations. As a quality auditor, you will serve as a quality liaison and advisor to various strive roles and departments such as kidney heroes, operational leadership and managers, education and training colleagues. You will serve as a care manager and quality subject matter expert, applying critical thinking and decision-making skills to determine medical appropriateness while maintaining production goals and Quality Assurance standards. This role reports to the Sr. Manager, Clinical Quality Auditor. The Day to Day

• Reviews and evaluates various patient file documentation and encounters, such as patient assessments/surveys, care plans, and recorded patient encounters against criteria to determine appropriate care delivery and documentation based on clinical practice guidelines and industry standards.
• Meets and maintains daily, weekly, monthly auditing productivity goals and quality assurance standards.
• Reviews internal assessments and care plans against NCQA case management and population health standards for timeliness and accuracy of documentation.
• Prepares, communicates, and collaborates with kidney heroes regarding individual staff audit findings, documentation of deficiencies, coaching, and education regarding audit activities and findings as well as reports for clinical management and supervisors of the audited resources.
• Assists with development, review, revision and maintenance of quality audit tools, processes, and resources as requested.
• Identifies and assists with risk and gap resolution regarding clinical auditing processes, resources, clinical software assessments, and care plans for compliance with accreditation and regulatory standards.
• Identifies and communicates system and/or operational issues hindering attainment of quality performance standards.
• Abstracts review related data/information accurately on review tool by the appropriate means. Accurately submits all administrative and review related documents to appropriate parties.
• Identifies and escalates situations which may pose quality, compliance, and safety risks that may adversely affect business operations.
• Supports program and clinical compliance requirements and activities. Participates in accreditation activities as needed such as case preparation or presentation, reviewing cases with internal and external clients.
• Participates and supports internal or external action plans to enhance the organization's quality and compliance posture.
• Maintains patient/provider confidentiality through proper use of computer passwords, maintenance of secured files, in adherence to HIPAA polices and professionalism to departmental and organizational standards, policies and procedures.

Minimum Qualifications

• Active, unrestricted RN license.
• 6+ years combined of related education, experience, or certification.
• Internet Connectivity - Min Speeds: 3.8Mbps/3.0Mbps (up/down): Latency Apply tot his job

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