Claims Risk Manager Jobs in Fresno, CA (NOW HIRING)

Responsibilities
Position Summary:
Under the supervision of the Director of PI/RM/CO, the Facility Risk Manager (FRM) has broad responsibility to protect the hospital's assets from loss. The FRM is responsible for coordinating the loss control efforts and advising management and administration on all potential sources of loss and for making recommendations to minimize or eliminate exposure. The structure and functions of the Risk Management Program are designed so as to comply with guidelines and standards of The Joint Commission (TJC), other regulatory agencies, and the UHS T.E.R.M.© Program. The FRM is responsible for overseeing and monitoring the facility-wide Risk Management Program and assist in Regulatory Compliance program to ensure compliance with all regulatory and accreditation agencies including TJC, Center for Medicare and Medicaid Services (CMS), California Department of Public Health (CDPH) as well as any other applicable state and federal laws and regulations governing mental health care facilities.
Qualifications:
Education : Graduate from an accredited program of professional nursing required; Bachelor's Degree Required
Preferred Experience: A minimum of three (3) years of experience in a behavioral health-care facility.
Licensure: Currently licensed to practice by the California State Board of Nursing.
Additional Requirements: CPR certification and successful completion of Crisis Prevention Intervention (CPI) training. CPI Training may be obtained during new hire orientation.
Qualifications
Specialized Skills and Knowledge
A strong knowledge of TJC, CMS, Occupational Safety and Health Administration (OSHA) and Patient Rights standards.
Knowledge of Joint Commission Standards, EMTALA, and HIPAA laws
Essential Job Duties:
Risk identification and Evaluation- Ensures appropriate and timely reporting of occurrences by maintaining a Healthcare Peer Review Reporting system (occurrence notification system); enters/ reviews/ edits incidents into the MIDAS Database. Receives and investigates reports of problems to determine appropriate response and establish record-keeping responsibilities. In the event of patient injury, establish direction from Corporate Risk Management in the appropriate action for defense strategy. 45%
Risk Reduction- Networks with department managers to implement system changes aimed at optimally reducing or eliminating causative factors and interfaces with the Performance Improvement Director, specific to the provision of patient care, and assessment of quality data 25%
Claims management- Notifies the Corporate Risk Manager of all Level III and IV events and completes Adverse Event Report (AER) for all Level III/IV events in Enterprise and submits the AER for review by the Corporate Risk Manger within 8 business days of the incident/notification of the incident and assists the Corporate Risk Management as needed to intervene, document and assist in the investigation of all claims. 20%
Loss Control and Prevention-Participates in facility Environmental Safety Rounds for all patient care areas, including outdoor use/grounds areas of facility at least monthly. 10%
Equal Employment Opportunity
It is the policy of the facility to provide equal opportunity in employment to all employees and applicants for employment. No person will be discriminated against in employment based on race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state, or local laws.
Americans with Disabilities Act
Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case basis in accordance with applicable law.
Service Excellence.
Service excellence is a part of all we do. Our standards include:
Treat everyone as a guest by making a good first impression, anticipating needs and displaying service recovery skills.
Demonstrate professionalism and excellence by looking professional, being accountable for actions and delivering excellence in our everyday work.
Practice teamwork by participating in decision making and process improvement, communicating effectively and focusing on the problem/issue, not the person.