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

Education and Work Experience:

• Associate's Degree in healthcare related field: Required
• Bachelor's Degree in Nursing (BSN): Preferred
• Two years' clinical or risk management experience in healthcare setting: Preferred

Essential Functions:

• Assists with identifying and managing actual and potential risks to the organization. Reviews and manages event reporting system related to grievances, complaints, workplace violence, security, property, facilities, and claims, and other events as assigned Participates in patient safety event review meetings and completes necessary follow up. Initiates review of events with high harm and potentially compensable events (PCEs).
• Acts as a liaison and resource to assess risk exposures in specific clinical and other situations (e.g. Facilities, Safety, Nursing, Pharmacy, Security, and Patient Relations). Works with Safety, Procurement, and Clinical Engineering and Clinical Operations to identify medical device and equipment failures for purposes of improving organizational risk, patient safety and for reporting to the Food and Drug Administration (FDA). Participates as member of varous organizational councils/committees to provide risk management perspective and input for purposes of managing organizational risk and promoting safety activities.
• Ensures timely and accurate response to inquiries for claims history and coverage information. Monitors evidence preservation (e.g. surveillance video, equipment, etc, and/or litigation holds). Collaborates with Risk Management Director or Manager, Claims team, or internal or external legal counsels to coordinate reviews processes and procedures. Obtains, maintains records and documents and provides them to internal or external legal counsels for preparation of testimony in pending litigation Safeguards documents obtained or developed for cause analysis to ensure documents/proceedings are protected from discovery. Participates in claims process which includes but is not limited to: coordination of depositions; response to interrogratories; requests for production of evidence; ensuring documentation and data management. Ensures timely and accurate response to inquiries for claims history and coverage information. Monitors evidence preservation (e.g. surveillance video, equipment, etc, and/or litigation holds) Attends trial as site representative as directed by internal and external legal counsels. Safeguards documents obtained or developed for cause analysis to ensure documents/proceedings are protected from discovery.
• Supports Risk Management Director and various department leaders in analyzing data (e.g. complaints, grievances, claims, lawsuits) to identify priority topics and audiences for targeted training and education. Assists department staff to coordinate inservices and education related to risk prevention, reduction, and mitigation strategies
• 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.