ZipRecruiter

Log In

1

Clinical Risk Manager Jobs in Ridgewood, NJ (NOW HIRING)

next page

Showing results 1-20

People also search for

All JobsClinical Risk JobsClinical Risk Manager JobsClinical Risk Manager Jobs in Ridgewood, NJ

Clinical Risk Manager information

What are the key skills and qualifications needed to thrive as a Clinical Risk Manager, and why are they important?

To thrive as a Clinical Risk Manager, you need a solid background in healthcare, risk management, and regulatory compliance, typically supported by a clinical degree and certifications such as CPHRM (Certified Professional in Healthcare Risk Management). Familiarity with incident reporting systems, electronic health records, and risk analysis tools is essential. Strong analytical thinking, communication, and problem-solving skills enable effective collaboration with healthcare teams and leadership. These competencies are vital for identifying, mitigating, and preventing risks to ensure patient safety and regulatory compliance in healthcare organizations.

How does a Clinical Risk Manager collaborate with clinical staff to improve patient safety?

Clinical Risk Managers work closely with nurses, physicians, and other healthcare professionals to identify potential risks and prevent adverse events. They often conduct root cause analyses after incidents, facilitate safety training sessions, and lead multidisciplinary meetings to discuss risk mitigation strategies. By fostering open communication and encouraging reporting of near-misses, they help create a culture of safety and continuous improvement within the healthcare facility.

What does a Clinical Risk Manager do?

A Clinical Risk Manager is responsible for identifying, evaluating, and mitigating risks related to patient safety and healthcare operations within a medical facility. They analyze incidents, develop policies to improve patient outcomes, and ensure compliance with healthcare regulations. Clinical Risk Managers also provide training to staff on best practices and collaborate with healthcare teams to implement safety initiatives. Their primary goal is to minimize potential legal liabilities and enhance overall quality of care.

What is the difference between Clinical Risk Manager vs Clinical Risk Coordinator?

AspectClinical Risk ManagerClinical Risk Coordinator
CertificationsCPHRM, RACCPHRM, RAC (sometimes)
Work EnvironmentHospitals, healthcare organizations, risk management departmentsClinics, healthcare facilities, risk management teams
ResponsibilitiesOversees risk management programs, develops policies, analyzes risksAssists in risk assessments, supports risk mitigation efforts, data collection

The Clinical Risk Manager typically holds more advanced certifications and has broader responsibilities in developing and overseeing risk management strategies. The Clinical Risk Coordinator supports these efforts through data collection and risk assessment assistance. Both roles are essential in healthcare risk management but differ in scope and seniority.

What job categories do people searching Clinical Risk Manager jobs in Ridgewood, NJ look for? The top searched job categories for Clinical Risk Manager jobs in Ridgewood, NJ are:
What cities near Ridgewood, NJ are hiring for Clinical Risk Manager jobs? Cities near Ridgewood, NJ with the most Clinical Risk Manager job openings:
Clinical Risk Manager jobs near you
Infographic showing various Clinical Risk Manager job openings in Ridgewood, NJ as of May 2026, with employment types broken down into 100% Full Time. Highlights an 71% In-person, and 29% Hybrid job distribution.
Director, Risk Adjustment - Hybrid

Director, Risk Adjustment - Hybrid

EmblemHealth

New York, NY • Hybrid

Other

Posted 12 days ago

Job description

Summary of Job

Develop and execute a comprehensive annual Risk Adjustment strategy that supports the Company strategies and improves the quality of care delivered to Emblem members, and to ensure the plan reimbursement accurately reflects the clinical diagnosis of our Medicare, Medicaid, and Affordable Care Act (ACA) members.  Develop and execute an annual Provider Risk Adjustment strategy to improve the accuracy of their diagnosis coding through education and engagement of our risk adjustment programs, reimbursement models and the ongoing development/ enhancement of support capabilities that complement their clinical practice model.  Prepare and present provider risk adjustment results at all Emblem joint operating committee meetings and monthly risk adjustment operational meetings.  Select and manage best-in-class risk adjustment vendors to drive continual improvement in the accuracy of diagnosis coding for Medicare, Medicaid, and ACA members.  Manage the ongoing performance, compliance and return on investment for each risk adjustment vendor.  Create and maintain a capabilities framework that is member and provider centric and is appropriate given for the clinical and demographic dynamics of members in risk adjusted products.  Manage the creation and timely production of risk adjustment operation and financial performance reports for all risk adjustment programs, and lead monthly risk adjustment operation meetings with Emblem leaders for VP, Risk Adjustment.  Be a strategic partner with the Actuarial, Quality and Product teams to enhance risk adjustment interventions and results.  Establish enterprise-wide monitoring and reconciliation reports to ensure that risk adjustment vendor results are accurately, timely and completely submitted to government entities.

Responsibilities

  • Develop, manage, and improve all retrospective risk adjustment programs to retrospectively identify, retrieve, code and submit diagnostic information from providers on EmblemHealth members enrolled in Medicare, Medicaid, and ACA products; manage all vendor relationships that support these retrospective activities.
     
  • Develop, manage, and improve prospective and concurrent risk adjustment programs to ensure accurate capture and reporting of diagnostic information for EmblemHealth members enrolled in Medicare, Medicaid and ACA products. 
     
  • Work with risk adjustment vendors and providers to execute in office assessment programs through which they 1) identify members based on clinical needs and quality gaps, 2) outreach to patients to encourage them to make office visits to receive services and 3) completely and accurately document all diagnostic conditions. 
     
  • Manage the In-Home Assessment risk adjustment vendor program.
     
  • Manage team completing revenue management opportunities for Medicaid, Medicare and Health Exchange products which includes identification of risk score opportunities, suspects, analysis and tracking of performance and attribution of interventions.
     
  • Direct EmblemHealth provider relationship and engagement risk adjustment activities.
     
  • Direct interaction with the CFO, CEO and other physician leaders of ACPNY groups and other large, sophisticated medical groups to integrate our programs into the provider's operations.
     
  • Analyze data to identify submission trends against historic data and membership changes and recommend opportunities to improve accuracy and completeness of all government submissions.
     
  • Collaborate with EmblemHealth medical management, quality, marketing & sales and network departments to identify opportunities to achieve efficiencies and improve effectiveness of risk adjustment activities by integrating both prospective and retrospective programs with care management, CMS Stars, Medicaid and Health Exchange quality programs, sales outreach and provider contracting. 

Qualifications

  • Bachelor's Degree in Healthcare, Finance, Business, or related field  (Required); Master's degree  (Preferred)
     
  • 10 - 12+ years of relevant, professional work experience  (Required)
     
  • Experience in healthcare, plan or provider operations and relations or related experience  (Required)
     
  • Leadership experience - including staff and process management experience  (Required)
     
  • Risk adjustment knowledge and expertise across Medicare, Medicaid, and Commercial exchange  (Required)
     
  • Capacity to multi-task at high detail-oriented level  (Required)
     
  • Strong communication skills (verbal, written, presentation, interpersonal) including executive leaders meeting experience  (Required)
     
  • Strong working knowledge of MS Office - Word, Excel, PowerPoint, Access, Outlook  (Required)
     
  • Strong analytical and logical skills paired with strong attention to detail  (Required)
Additional Information
  • Requisition ID: 1000003033
  • Hiring Range: $135,000-$253,800

Apply