Sr. Manager, Clinical Documentation Auditor

Strive Health

Strive Health

This job is no longer accepting applications

See open jobs at Strive Health.
Denver, CO, USA · Remote
Posted on Wednesday, December 6, 2023

What We Strive For

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, engagement and comprehensive coordinated care. Strive’s model is driven by a high-touch care team that integrates with local providers and spans the entire care journey from chronic kidney disease through end-stage kidney disease, leveraging comparative and predictive data and analytics to identify at-risk patients. 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 talent in the healthcare community and set a new standard for how kidney care should be done.

Why We’re Worth the Application

  • We Strive for excellence and were recognized as one of America’s Best Startup Employers for 2023 by Forbes, Circle of Excellence, American Society of Transplantation, 2023, Best Places to Work – Denver, Comparably.com, 2022, Best Places to Work – Denver, Built in Colorado, 2022
  • We derive innovation and ideas from through authentic diversity intentionally building a team that represents the populations we serve in partnership with our Employee Resource Groups:
    • Strive Forward - LGBTQ
    • Underrepresented Minorities
    • Women and Allies
  • We care and support our Strivers within and beyond work to feel fully charged and empowered through our generous wellbeing offerings including:
    • Flexible time off
    • Companywide wellbeing days
    • Volunteer time off
    • Leave packages including a sabbatical, parental leave and eight weeks paid for living donor
    • Professional development
    • A dedicated certified financial planner
    • Headspace, Carrot Fertility and Gympass for all Strivers
  • We like to have fun by celebrating our successes as a team through team building, company gatherings, trivia, wellbeing raffles, pajama days, a companywide book club and more.
  • We value tenacity to help us overcome obstacles with grit and determination to deliver compassionate kidney care.

Sr. Manager, Clinical Documentation Auditor, RN

The Sr. Manager, 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 and other internal and regulatory standards. The Sr. Manager, 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

  • Provide guidance, leadership, and education on the auditing of 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.
  • Identifies opportunities from the review of 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 on strategies and recommendations to improve the auditing program.
  • Educates management and team members on adherence procedures.
  • Influences change through clear explanation of findings and next steps for documentation across all care teams.
  • Client facing expertise with medical record demonstrations for health plan partners
  • Policy & procedure SME
  • Program management of the Auditing strategy and design
  • Supports the day-to-day supervision of Central Audit Team in collaboration with the Quality leadership team
  • High degree of time and priority management to lead and audit charts.
  • 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.
  • Payor delegation & NCQA audit support

Minimum Qualifications

  • Active, unrestricted RN license
  • 5+ years of experience in documentation, reporting, and auditing in a healthcare or managed care environment
  • Internet Connectivity - Min Speeds: 3.8Mbps/3.0Mbps (up/down): Latency <60 ms

Preferred Qualifications

  • NCQA Case Management or Health Plan accreditation standards and process experience
  • NCQA Accreditation Survey Patient File presentation 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.
  • 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 Population Health accreditation standards and process experience
  • Knowledge of the organization of medical records, medical terminology, and disease process
  • Remote experience preferred

Annual Salary Range: $107,400.00 - $134,200.00

Strive Health offers competitive compensation and benefits, including Health insurance, Dental insurance, Vision insurance, 401k Retirement Plan with Employer Match, Life and Accidental Death & Dismemberment insurance, Disability insurance, Health Savings Account, Flexible Spending Account, paid company holidays, in addition to Vacation Time Off. An annual performance bonus, determined by company and individual performance, is available for many roles as aligned to Strive Health guidelines.

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 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 talentacquisition@strivehealth.com

This job is no longer accepting applications

See open jobs at Strive Health.