Claims Risk Management Jobs in California (NOW HIRING)

Education and Work Experience:

• Bachelors's degree nursing, business administration, hospital administration or equivalent combination of education/related experience: Required
• Seven years' of progressive experience in healthcare or general risk management in acute and/or ambulatory settings: Required
• Five years' leadership experience: Required

Licenses/Certifications:

• Certified Professional in Healthcare Risk Management (CPHRM): Required within two years of hire

Essential Functions:

• Partners with clinical and non-clinical staff to develop, implement, monitor and improve structures required to achieve high quality, safe, cost-effective health care. Oversees Risk reviews of events and complaints that pose organizational risk and assists in appropriate responses. Participates in patient safety event review meetings and conduct necessary follow up. Directs and ensures efficient and adequate review analysis, and follow up are completed for high harm and potential compensable events (PCEs).
• Provides administration and strategic oversight of all activities designed to reduce risk exposure and improve safe patient care (e.g. Cause Analysis, risk assessments, and performance improvement teams). Establishes and evaluates organizational systems and processes related to event reporting data and improving outcomes. Guides leaders and teams in assessing risk exposures in specific clinical and other situations (e.g. Facilities, Safety, Nursing, Pharmacy, Security, and Patient Relations). Collaborates with senior leadership to provide risk management perspective and input for purposes of managing organizational risk and promoting safety activities.
• Provides oversight and support with analysis and monitoring activities related to claims trends, risk mitigation activities and solutions development in conjunction with market Risk Management, Claims team, and Legal department. Attends trial as site representative as directed by internal and external legal counsels. Collaborates with senior leadership, Claims team and internal and external counsels on claims and litigation strategies and actions. Safeguards documents obtained or developed for cause analysis to ensure documents/proceedings are protected from discovery.
• Leads the development of risk management program, policies and procedures and enhances existing risk management programs, policies, and procedures consistent with established organizational philosophies and values. Conducts periodic review and monitoring of risk management programs and solutions. Oversees enterprise wide risk management functions. Serves as an expert and maintains a network of informational sources and experts, performs risk surveys, inspects patient care areas and reviews facilities to assess loss potential.
• Develops, Coordinates and Provides Risk Management Training and Education Programs: Collaborates with senior leaders and risk teams to analyze data (e.g. complaints, grievances, claims, lawsuits) to identify priority topics and audiences for targeted training and education Utilizes external data (local, state, national) to identify high-risk topic areas and focus groups for targeted education. Offers risk educational program on a regular basis and as requested including organization-wide presentations as well as specialty specific.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.