Sr. Clinical Documentation Auditor at Strive Health (Remote)

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Overview
Strive Health
Strive Health is built for purpose- to transform a broken kidney care system. We are fundamentally changing the lives of kidney disease patients through early identification and engagement, comprehensive coordinated care, and home-first dialysis. Strive's model is driven by a high-touch care team that integrates with local providers and spans the entire care journey from CKD through ESRD, leveraging comparative and predictive data and analytics to identify patients at risk. Strive Health's interventions significantly reduce the rate of emergent dialysis crash, cut inpatient utilization, and significantly improve patient outcomes and experience. Come join our journey as we create THE destination for top ta lent in the Healthcare community and set a new standard for how kidney care should be done.
Sr. Clinical Documentation Auditor
The Clinical Documentation Auditor is responsible for supporting the Care Management team by providing ongoing staff audits to ensure compliance with documentation requirements. Utilizes clinical expertise for the review of patient files and care plans against appropriate criteria in conjunction with accreditation, contract requirements, critical thinking, and decision-making skills to determine medical appropriateness, while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with NCQA Standards other internal and regulatory standards. The Clinical Documentation Auditor will provide ongoing feedback and education to the clinical management team regarding accurate documentation to improve overall health outcomes for patients and continuity of care.
Essential Functions
  • Reviews and interprets patient files and care plans against criteria to determine appropriate documentation based on clinical practice guidelines and appropriateness of care; determines if the patient file documentation supports the patients' need for services.
  • Reviews internal assessments and care plans against NCQA case management and population health standards for timeliness and accuracy of documentation.
  • Preparation of the individual staff audit findings, documentation of deficiencies as well as developing final staff reports for clinical management and supervisors of the audited resources.
  • Collaborates with clinical management to provide opportunities for improvement regarding patient files and care planning documentation.
  • Educates management and team members on adherence procedures.
  • Creates and manages review process and support tools.
  • Abstracts review related data/information accurately and timely on appropriate review tool by the appropriate means. Accurate and timely submission of all administrative and review related documents to appropriate parties.
  • Performs ongoing reassessment of review process to offer opportunities for process improvement and/or change.
  • Identifies gaps in clinical software assessments and care plans for compliance with accreditation and regulatory standards.
  • Foster positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
  • Responsible for attending training, scheduled meetings, and for maintenance and use of current/updated information for review.
  • Maintains patient file confidentiality through proper use of computer passwords, maintenance of secured files, adherence to HIPAA polices.
  • Actively cross-trains to perform other duties of contractual requirements of Strive Health to provide a flexible workforce to meet client/consumer needs.
  • Meet in person with internal and/or external stakeholders to facilitate team and business priorities/opportunities.

Qualifications
Minimum Qualifications
  • Active, unrestricted RN license
  • At least 3 years of experience in documentation, reporting, and auditing in a healthcare or managed care environment.
  • NCQA Case Management accreditation standards and process experience.
  • NCQA Population Health accreditation standards and process experience.
  • Strong clinical assessment and critical thinking skills
  • Excellent verbal and written communication skills
  • Ability to work in a team environment.
  • Flexibility and strong organizational skills needed.
  • Proficiency in Microsoft Office, Adobe Acrobat and internet/web navigation.
  • Business travel up to 15%

Preferred Qualifications
  • Care Management Certification
  • Bachelor's Degree in Nursing or other health-related field required; Master's in Nursing or another health-related field preferred.
  • Will substitute 5 or more years of clinical experience along with an associate degree and RN licensure in place of the bachelor's degree and RN licensure.
  • NCQA Accreditation Survey Patient File presentation experience.
  • Knowledge of the organization of medical records, medical terminology, and disease process
  • Remote experience preferred

Strive Health offers competitive compensation and benefits. An annual performance bonus, determined by company and individual performance, is available for many roles and aligned to Strive Health guidelines. Learn more about our benefits here
Strive Health is an equal opportunity employer and drug free workplace. At this time Strive Health is unable to provide and 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 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 [email protected]
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Technology we use

  • Engineering
  • Product
  • Sales & Marketing
    • JavaLanguages
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    • AxureDesign
    • ConfluenceManagement
    • SmartsheetManagement
    • SalesforceCRM

An Insider's view of Strive Health

What are some social events your company does?

In support of Kidney Awareness, Strive participated in a virtual walk to fight kidney disease and celebrate hope for those suffering. As a team, we decided to raise money in support of the National Kidney Foundation, and hike together in the mountains of Burbank. It was so much fun! We enjoyed the morning and even raised over $2000!

Voranan

Head of Care Model Design and Innovation

What's the biggest problem your team is solving?

The Market Strategy team is working on how to ensure we focus on the right patients with the right clinicians at the right time. We get to solve this with multiple departments including analytics, operations, clinical delivery, etc. which makes it especially rewarding to be able to impact our patients while working alongside so much of the company.

Jonathan

Vice President, Market Strategy

How has your career grown since starting at the company?

Quickly and I love it! This is a fast paced and challenging environment where we are constantly innovating and thinking outside the box to go where no one has gone before in kidney care industry. Despite the growth, we have been able to stay true to our values and care for others first.

Kristen

Senior Director, Clinical Informatics

How do you empower your team to be more creative?

Ownership. A critical part of the team is that people know what they should be working on and what they are accountable for delivering. This gives them a chance to build the rapport with their non-technology counterparts to best understand the business components that relate to their expertise. It’s beautiful to see team members become creative.

Matt

Vice President, Data Strategy and Analytics

What kinds of technical challenges do you and your team face?

Interoperability! We are in the race along with the rest of the country to determine the best way to exchange healthcare data with external partners and providers in a seamless workflow. Our goal is to determine how we can efficiently utilize technology to meet our end users where they are, and streamline their processes!

Kristen

Senior Director, Clinical Informatics

What are Strive Health Perks + Benefits

Culture
Volunteer in local community
Friends outside of work
Eat lunch together
Intracompany committees
Daily sync
Team owned deliverables
Team based strategic planning
Group brainstorming sessions
Open office floor plan
Diversity
Highly diverse management team
Unconscious bias training
Diversity manifesto
Mean gender pay gap below 10%
Diversity Employee Resource Groups
Hiring Practices that Promote Diversity
Health Insurance & Wellness Benefits
Flexible Spending Account (FSA)
Disability Insurance
Dental Benefits
Vision Benefits
Health Insurance Benefits
Life Insurance
Pet Insurance
Wellness Programs
Mental Health Benefits
Retirement & Stock Options Benefits
401(K)
Company Equity
Performance Bonus
Child Care & Parental Leave Benefits
Generous Parental Leave
Flexible Work Schedule
Remote Work Program
Family Medical Leave
Vacation & Time Off Benefits
Unlimited Vacation Policy
Generous PTO
Paid Volunteer Time
Paid Holidays
Paid Sick Days
Perks & Discounts
Casual Dress
Company Outings
Some Meals Provided
Happy Hours
Parking
Recreational Clubs
Home Office Stipend for Remote Employees
Professional Development Benefits
Job Training & Conferences
Diversity Program
Lunch and learns
Cross functional training encouraged
Promote from within
Continuing Education stipend
Time allotted for learning
Customized development tracks
Paid industry certifications

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