Under the combined influence of climate change and urban development, the risk of urban flooding caused by extreme weather events has increased significantly, making assessing flood vulnerability and resilience increasingly crucial for urban flood management. With the 45 counties in Qinghai Province as the research objects, the hazard risk of flood and exposure are combined to study their vulnerability. At the same time, resilience is evaluated by the indicators selected from four dimensions (society, economy, environment, and infrastructure). Through Z-scoring, the vulnerability and resilience of each county are clustered into four groups to explore their associations from a spatial balance perspective. Obstacle factor analysis is introduced to summarize the key factors affecting the improvement of urban resilience in Qinghai Provence. The results show that the eastern areas of Qinghai experience high vulnerability to flooding because of high levels of hazard and exposure. What is more, Xining, Haidong, and Haixi experience a high level of resilience. A strong spatial mismatch between vulnerability and resilience exists in Qinghai, with 24 counties (58%) being self-adapted, 8 counties (18%) over-abundant, and 11 counties deficient in terms of nature–nurture. The length of levee and number of beds in medical institutions are the main obstacles to resilience in Qinghai. The research results can provide a theoretical and scientific basis for future urban flood management and resilience development in the Qinghai–Tibetan Plateau.