Clinical Quality Auditor

What We Strive For

At Strive Health were 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 Youll 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 organizations 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 <60 ms.
• Ability to travel and be onsite to meet business needs.

Preferred Qualifications

• Bachelors degree in nursing or another healthcare-related field preferred.
• Application of NCQA program(s) accreditation standards and processes experience.
• NCQA Accreditation Survey experience or other industry related audits.
• Proficiency in Microsoft Office Adobe Acrobat and internet/web navigation.
• Case Management Certification.
• Knowledge of the organization of medical records medical terminology and disease process.
  

About You

• Strong clinical assessment and critical thinking skills.
• Attention to excellence - quality driven detailed oriented innovative and accountable.
• Excellent verbal and written communication skills.
• Ability to work in a team environment.
• Flexibility and strong organizational skills needed.

Annual Base Salary Range: $74000 - $90000

Strive Health is an equal opportunity employer and drug free workplace. At this time Strive Health is unable to provide work visa sponsorship. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability status protected veteran status or any other characteristic protected by law. Please apply even if you feel you do not meet all the qualifications. If you require reasonable accommodation in completing this application interviewing completing any pre-employment testing or otherwise participating in the employee selection process please direct your inquiries to

We do not accept unsolicited resumes from outside recruiters/placement agencies. Strive Health will not pay fees associated with resumes presented through unsolicited means.

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