Clinical Quality Auditor, Nurse Practitioner

Clinical Quality Auditor, Nurse Practitioner United States How You’ll Make An Impact At Strive Health, patients come first. We’re on a mission to transform chronic conditions by identifying risk earlier, coordinating thoughtful care, and supporting people through every stage of their health journey. Our work reduces emergency visits, improves outcomes, and helps patients live fuller lives. You’ll work alongside passionate Strivers who care deeply about making an impact, show up for one another as One Team, and find ways to elevate the everyday. If you’re looking for meaningful work where your contributions truly matter, you’ll feel right at home at Strive! 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, plus 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 birth‑giving, 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 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 appropriate quality criteria in conjunction with program, accreditation, and industry requirements. You will support various Kidney Hero roles regarding case auditing, outcomes, coaching, quality improvement strategies, resource development, and other activities to promote continuous quality improvement. This support includes root‑cause analysis and remediation recommendations. You will serve as a quality liaison and advisor to multiple departments such as kidney heroes, operational leadership, education, and training colleagues. You will apply 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, and 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 – Support updates to processes, templates, and guidance materials. Identify, support resolution, and elevate 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 related education, experience, or certification. Internet connectivity – Minimum speeds 3.8 Mbps/3.0 Mbps (up/down); latency Ability to travel and be onsite to meet business needs. Preferred Qualifications Application of NCQA program(s) accreditation standards and processes experience. Experience with 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. 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. 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. 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 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 Strive Health