Clinical Risk Manager Jobs in California (NOW HIRING)

Education and Work Experience:

• Bachelor's degree in Nursing or other clinical field, risk management, legal or other related field: Required
• Master's degree: Preferred
• Seven years' experience in healthcare or general risk management: Preferred
• Five years' leadership experience: Preferred

Licenses/Certifications:

• Certified Professional in Healthcare Risk Management: within two (2) years of hire

Essential Functions:

• Has oversight of 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).
• Analyzes event reporting data and makes recommendations for future review action. Contributes and participates in activities designed to reduce risk exposure and improve safe patient care (e.g. Cause Analysis, Failure Mode Effects Analysis (FMEA) and performance improvement teams). Facilitates risk assessments as needed to proactively identify and evaluate areas of risk. Acts as a liaison and resource to market Risk Management to assess risk exposures in specific clinical and other situations (e.g. Facilities, Safety, Nursing, Pharmacy, Security, and Patient Relations). Oversees reporting requirement of medical device and equipment failures. Participates as member of various organizational councils/committees to provide risk management perspective and input for purposes of managing organizational risk and promoting safety activities.
• Analyzes and monitors claims trends and develops risk mitigation activities and solutions in conjunction with market Risk Management, Claims team, and Legal department. Manages claims process and ensures timely production and submission to internal and external legal counsels. Coordinates with Claims team and internal and external legal counsel to successfully manage, mitigate, and resolve claims. Oversees collection and dissemination of confidential claims information and data to authorized individuals. Oversees and reviews periodic risk management claims reports as needed. Coordinates the 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. Recommends payment for replacement of lost property after claims evaluation. In collaboration with Claims team and internal and external legal counsels, negotiates settlement of small claims within administrative authority and advises billing department of appropriate action for unpaid accounts involved in litigation. Safeguards documents obtained or developed for cause analysis to ensure documents/proceedings are protected from discovery.
• Develops risk management program, policies and procedures and enhances existing risk management programs, policies, and procedures consistent with established organizational philosophies and values
• Collaborates with various departments 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.