Clinical Quality Auditor, Nurse Practitioner - Denver, CO

What You’ll Do 

As the Clinical Quality Auditor, you will be responsible for completing quality review processes for care management and care delivery 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 Performance. 

The Day to Day 

• Review clinical documentation and encounters (assessments/surveys, plans of care, recorded encounters) to ensure alignment with clinical guidelines, NCQA standards, and industry best practices. 
• Meet auditing productivity targets (daily/weekly/monthly) while maintaining quality assurance standards. 
• Validate timeliness and accuracy of internal assessments and plans of care against NCQA Case Management and Population Health requirements. 
• Communicate audit findings and provide coaching/education to Kidney Heroes and clinical leaders, clearly documenting deficiencies and improvement opportunities. 
• Develop and maintain audit tools and resources by supporting updates to processes, templates, and guidance materials. 
• Identify, support resolution, and escalate risks/gaps impacting quality, compliance, safety, or accreditation readiness. 
• Flag system or operational barriers that impede attainment of quality performance standards and recommend improvements. 
• Accurately abstract and submit audit documentation using designated tools and route required materials to appropriate stakeholders. 
• Support compliance and accreditation activities (case prep/review, action plans) while maintaining HIPAA confidentiality and professionalism. 

Minimum Qualifications 

• Active, unrestricted NP 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 

• Application of NCQA program(s) accreditation standards and processes experience. 
• Experience in GDMT protocols along with knowledge of proper care of patients with multiple complex medical conditions. 
• Familiar with documentation and coding standards for HCC and HEDIS.
• 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: $99,000 - $124,000. This position is also eligible for a target annual bonus of 10%.