Risk Manager

The Risk Manager is responsible for the primary risk identification processes throughout the Community Group Practice (CGP) as directed by the Risk Management Plan. With the information gathered, the risk manager analyzes loss and other data sources, and develops risk mitigation activities, metrics for monitoring these activities, and supports the claim reporting function when risk issues are identified that could lead to a liability claim against the organization.

1. Reviews all events and near misses reported through the event reporting system and any other means. Make appropriate referrals for event investigation and follow-up to business unit owners.
2. For any Serious Safety Events and Sentinel Events, leads or contributes to investigation of event (to include staff interviews, review of records for timeline development, verification of policy/procedure compliance or variance). Collaborate with QI Coordinators around Root Cause Analysis.
3. Completes medical record reviews, compares current practice against best practice guidelines and provides recommendations to reduce risk and improve patient care processes.
4. Completes and submits “First Report” Claim Advisory Forms to Claims using currently established guidelines.
5. Leads/Organizes disclosure teams for adverse outcomes when appropriate for disclosure.
6. Collates, writes and disseminates quarterly Risk Analysis and Summary report
7. Contributes to the Risk Dashboard and other metrics
8. Coordinates and/or conducts annual Risk Assessment in high-risk area or process and implements actions plans from findings.
9. Supports Patient Relations with Complaint and Grievance responses specific to harm (and potential for liability).
10. Investigates potential compensable events, which may include interviews of medical staff, employees, visitors, and patients, and assesses potential liability.
11. Identifies potential loss conditions and practices and evaluates their significance. Reports findings and devises remedial action plans.
12. Develops and implements loss prevention educational programs and materials.
13. Drafts or reviews documents to reduce institutional exposure to liability.
14. Writes and reviews policies and procedures, develops educational safety programs and materials, and contributes to quality assurance mechanisms.
15. Performs other duties as required or assigned.

• Bachelor’s with 5 years of healthcare experience in insurance claims, risk management, project management, or as a health care provider, or the equivalent combination of education and experience required.
• Excellent written and verbal communication skills required.
• Flexibility, tolerance, and demonstrated ability to prioritize multiple tasks with attention to detail essential.
• Demonstrated ability to interact with a wide diversity of people and situations while maintaining a customer focus.
• Ability to adapt to stressful situations quickly and effectively.
• Strong knowledge of healthcare clinical fundamentals, patient safety standards, and performance improvement standards.
• Strong knowledge of performance improvement tools and techniques, ability to perform data analytics, and lead teams
• Openness to growth and learning in a collaborative team environment, consistent with the goals and principles that guide the organization.
• Ability and desire to function both collaboratively and independently.
• Computer skills and knowledge of applicable software programs.
• Strong history of positive and cooperative relationships with senior leaders and physicians.
• Flexibility with schedule

• Certified Professional in Healthcare Risk Management (CPHRM), Associate in Risk Management (ARM), or Certified Professional in Patient Safety (CPPS). One designation must be achieved within one year of eligibility of certification.