Insurance Risk Manager Jobs in West Virginia (NOW HIRING)

OneOncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. Our team is bringing together leaders to the market place to help drive OneOncology's mission and vision.

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, urology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve.

Job Description:

Role Summary:

The Risk Manager is responsible for the day-to-day risk management activities for designated Sun State Medical affiliated practices, including investigating, managing, and analyzing risk management data; complying with risk management standards of AAAHC, other accrediting agencies, and local State Department of Health; and conducting risk management educational programs. The Risk Manager is responsible for the coordination and investigation of patient and visitor events, provides documentation of all related data and facilitates resolution of reported incidents. This position supports SMS-affiliated practice's objective of enhancing and promoting patient safety and quality of care and minimizing loss to protect the assets of the facility. This individual participates in formulating risk reduction strategies, policy and/or organizational changes.

Responsibilities:

Risk Management Program

• Promotes positive collaboration with other members of the Risk Management team to support the overall growth and development of the SMS Risk Management program.

• Coordinates assigned risk management programs to meet local practice needs.

• Contributes to the identification, planning, and drafting of Risk Management and Safety Policies and Procedures.

• Engages in weekly Risk Management team huddles by providing regular updates and input into collaborative problem-solving endeavors.

• Performs review and analysis of all risk event reports for Risk Management, quality of care, regulatory and insurance concerns utilizing RMIS technology.

• Utilizes RMIS to manage, document, and store relevant risk management information.

Incidents and Events

• Communicates importance and encourages the use of incident reporting system to regional providers and staff.

• Supports a Just Culture reporting environment and supports all quality and safety projects.

• Completes investigation of reportable events, including chart review, and ensures that all regulatory reporting has been appropriately completed.

• Guides operations and nursing regarding optimal risk mitigation strategies following events.

• Moderates Root Cause Analysis investigations, which includes assessing the need for focused or peer reviews.

• Tracks Action Plans to ensure completion and appropriate review.

• Prepares various incident summary reports; provides all required documentation for investigations, activities and resolutions related to the reported incident(s).

• Identifies regional organizational risk through trend analysis of incidents, incident letters, reports, etc.

Claims & Litigation Management

• Reports incidents and claims to proper insurance carriers within SMS reporting guidelines.

• Maintains regular status notes on pending claims and litigation within RMIS.

• Prepares various reports related to pending litigation utilizing RMIS technology.

Risk Management Resource

• Acts as an independent resource person by presenting relevant risk management issues for discussion and evaluation.

• Keeps abreast of appropriate regional regulatory requirements related to regional risk management.

• Maintains clinical knowledge of best practices to ensure relevant and progressive risk management support.

• Active participation on committees directed toward promoting quality of care and with availability to attend/cover other Committee meetings.

• Educates operational teams on risk and safety issue reporting.

• Engages with clinical providers and staff by demonstrating a Risk Management presence through virtual meeting attendance and/or on-site visits.

Risk Management Education

• Assists in developing and presenting educational programs to raise staff awareness of risk exposure and the impact on professional liability.

• In conjunction with human resources and operations, the manager provides risk management orientation and support to new staff and providers within their Region.

• Coordinates and delivers risk management program education to new acquisitions and supports the SMS Integration team as requested.

Additional responsibilities as assigned to help drive our mission of improving the lives of everyone living with cancer.

Required or Preferred Qualifications:

• Bachelor's Degree or commensurate experience required.

• Minimum of three to five (3-5) years of risk management experience.

• Strong clinical background preferred.

• Current CPHRM certification or attainment of CPHRM Certification within one year of hire.

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