Insurance Risk Analyst Jobs in Houston, TX (NOW HIRING)

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

The Risk Management professional in this position is responsible for the organization, analysis and management of all Risk Management activities of a facility, group of facilities, or geographic location as assigned. Responsibilities include, but may not be limited to, the identification, prevention and management of clinical and non-clinical risks and day-to-day administration of the risk management program. Responsible for working with a high degree of autonomy as well as collaboration within the assigned facility(s) and the broader complex organization to build effective relationships and establish credibility with staff, senior management, physicians, patients and visitors in order to advance the risk management objectives, assure compliance with regulatory mandates and standards, improve patient safety and quality of care, and protect organizational assets. Acts as a subject matter expert, resource, internal consultant, and educator for risk management issues. The role encompasses the key risk management functional areas of: loss prevention and reduction, claims management, risk transfer through insurance, regulatory and accreditation compliance, risk management operations, and bioethics. Position requires "on-call" availability. Position reports directly to a facility based administrative leader and dotted line reporting to the system Chief Risk Officer and System Director of Clinical Risk Management.Job Description

Minimum Qualifications

Education: Healthcare related Baccalaureate degree required,Bachelors of Science in Nursingpreferred

Licenses/Certifications: Certified in Healthcare Risk Management (CPHRM) or able to obtain within two (2) years of employment

Experience / Knowledge / Skills:

• Minimum of five (5) years of progressive experience in a hospital-based clinical role;experience in post-acute care settings is strongly preferred for Risk Managers primarily responsible for risk management programs supporting Post-Acute.

• Minimum of four (4) years experience in a clinical risk management role or equivalent experience in healthcare managerial role, or a medico-legal role

• Knowledge of Risk management principles and key functions and general knowledge and familiarity with healthcare related regulatory and accreditation requirements

• Ability to demonstrate flexibility, discretion and exercise emotional maturity in difficult situations, and work collaboratively and independently to achieve results

• Strong written and oral communication skills, presentation skills, and leadership skills required.

• The ability to organize, build and effect change through use of data, influence, and working with teams and the ability to influence change without direct authority.

• Conflict management and negotiation skills a plus.

Principal Accountabilities

• Has full responsibility for day to day operations of the risk management program that includes an enterprise risk approach to exposures, loss control/loss prevention activities and analysis.

• Accountable for identifying strategies and solutions to enhance the healthcare operations environment and initiates techniques to reduce exposures to risks inherent in such environment.

• Supports and coordination of facility risk assessments.

• Provides consultation and assistance to facility leadership, staff, and physicians on day to day risk management issues and provide assistance to System Legal and Risk Management Services as needed. Availability for "on-call" duties required.

• Reviews and "triaging" of all occurrence reports in Variance Reporting System (VRS) related to patient, visitors and non-employee events to assess the risk/liability potential, direct the issues to the most appropriate function for investigation or resolution; This excludes general Customer Service complaints.

• Reviews and analyzes occurrence data, claims data, and other data sources for risk related trends and report to facility leadership and System Risk Management, and develop targeted initiatives to address risk trends.

• Collaborates with Patient Safety in the identification and analysis of Patient Safety Events and serve as Risk Management representation in the Quality Filter process and on quality/patient safety committees as needed.

• Proactively identify risk management related training and education needs and plan, develop and present training designed to minimize the frequency and reduce the severity of actual and potential risks.

• Participates in or lead in the disclosure of unexpected/adverse clinical outcomes; Provide education and training on the disclosure process and policy to key management and physicians who will participate in patient disclosures.

• Serves on appropriate clinical and non-clinical committees where risk management expertise is beneficial in a capacity of expert advisor or consultant or attend as appropriate based on availability.

• Reviews, monitors , manages, and investigates compliance with various codes, laws, rules and regulations mandated by state and federal agencies or enforcement authorities, including compliance with the medical device program (SMDA) standards and other regulatory duties as defined by System Risk Management and System Legal Services.

• Reviews high-risk patient complaints that may be the source of potential legal action, discuss and offer solutions when possible to resolve patient and/or family grievances perceived as potential liability claims in collaboration with patient representatives. This excludes general Customer Service complaints.

• Assists System Risk Management in the coordination of information gathering and interviews related to claims and suits and interact with legal counsel as needed.

• Serves as a liaison between System Insurance Services and facility regarding actual and potential claims related to physical losses.

• Supports the investigation of safety or security incidents in collaboration with Occupational Health and Safety, or Security as appropriate and participate in facility based safety committees where risk management expertise may be beneficial.

• Reviews and recommends new or amended policies and procedures including providing support for the policy and procedure committee.

• Participates in and support Emergency Preparedness initiatives.

• Support system Risk Management goals and objectives as well as facility-based goals which contribute to the achievement of the overall strategic objectives of the organization.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann's service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.