Clinical Quality Auditor, Nurse Practitioner - Denver, CO

Clinical Quality Auditor, Nurse Practitioner United States (Job Title) Benefits 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, health and flexible spending accounts. Financial & Retirement Support – Competitive compensation with a performance-based bonus program, 401(k) with employer match, and financial wellness resources. Time Off & Leave – Paid holidays, vacation time, sick time, and paid birthgiving, bonding, sabbatical, and living donor leaves. Wellness & Growth – Family forming services through Maven Maternity at no cost, 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 and care delivery programs. This role ensures appropriate clinical and care delivery practices are utilized and case documentation meets established standards consistently to support internal and external quality standards, compliance, and expectations. You will review patient files, care plans, and interactions against quality criteria, program, accreditation, and industry requirements. You will support various kidney hero roles regarding case auditing, outcomes and coaching, quality improvement strategies, resource development, and other activities to promote continuous quality improvement. You will provide quality support to operational managers and leadership, communicate and facilitate resolution for quality risks such as root cause analysis and remediation recommendations, and serve as a quality liaison and advisor to Strive roles and departments. You will act 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 escalating 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: minimum speeds 3.8 Mbps download / 3.0 Mbps upload, latency 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 and knowledge of proper care of patients with multiple complex medical conditions. Familiarity 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 processes. About You Strong clinical assessment and critical thinking skills. Attention to excellence – quality‑driven, detail 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%. Final compensation will be determined based on location, experience, and qualifications. Strive Health is an equal opportunity employer and drug‑free workplace. We do not currently 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. If you require reasonable accommodation in completing this application, interviewing, or completing any pre‑employment testing, please direct your inquiries to View email address on click.appcast.io. We do not accept unsolicited resumes from outside recruiters/placement agencies. Strive Health will not pay fees associated with resumes presented through unsolicited means. #J-18808-Ljbffr