Insurance Risk Manager Jobs in Beverly, MA (NOW HIRING)

Hours: 40 hours per week; Monday through Friday. This position follows an on-call schedule and may require you to work nights/weekends.
Location: 100% Remote (option to work onsite available)
Job Profile Summary
This role focuses on ensuring the organization's business activities are conducted ethically and in compliance with relevant regulations, laws, and standards. In addition, this role focuses on performing the following Risk Management duties: Identifies, assesses, reduces, and mitigates risks to the organization. Responsibilities also include characterizing potential risks and assessing vulnerability of critical assets to specific risks, risk analysis and modelling to assess probability of specific risks occurring and evaluate/value the impact/consequences of occurrence, developing process and procedures to report on, and manage and mitigate risks to acceptable levels, internal and external stakeholder reporting, including regulatory reporting. A professional individual contributor role that may direct the work of other lower level professionals or manage processes and programs. The majority of time is spent overseeing the design, implementation or delivery of processes, programs and policies using specialized knowledge and skills typically acquired through advanced education. A specialist level role that is a recognized subject matter expert in job area typically obtained through advanced education and work experience. Typically manages large projects or processes with limited oversight from manager, coaches, reviews and delegates work to lower level professionals, resolving difficult and often complex problems.
Job Overview
Responsible for developing, implementing and coordinating risk management activities, including the identification, evaluation and treatment of risk in the organization. Develops and manages a systematic process to identify, assess, and treat actual and potential exposures to loss. Supports the incident reporting system, evaluates trends and patterns in care and services and work closely with the medical staff, clinical, and administrative staff to reduce the risk of patient harm.
Job Description
Minimum Qualifications:
1. Bachelor's degree in Law, Regulatory Affairs, Compliance, Nursing, Healthcare Administration or related field.
2. Five (5) years of clinical experience or risk management experience.
Preferred Qualifications:
1. Master's Degree
2. Professional Healthcare Risk Management (CPHRM).
3. Seven (7) years of clinical experience or risk management experience.
Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.
1. Proactively evaluates areas of organizational risk based on internal assessment and external benchmarking, and implements strategies, policies, and practices that promote patient safety.
2. Collaborates in reviewing events involving patient harm or significant deviation of standard procedures which could cause patient harm, and in conducting the harm analysis of such events.
3. Reviews and evaluates aggregate adverse event and claims data to identify high-risk activities, procedures and departments.
4. Compiles statistics on all areas of risk throughout the hospital to use in identifying, evaluating, eliminating or reducing incidents in high-risk areas. Creates meaningful reports and graphic presentations to assist managers and administrators in assessing the impact of patient safety practices on loss prevention.
5. Initiates the investigatory process and manages investigations related to adverse outcomes and events, including interviewing staff, reviewing medical records, assessing policies and procedures, and identifying best practices.
6. Initiates safety event huddles, leads the review of adverse events, facilitates root cause and other causal analyses, and works with clinical and administrative leaders in designing solutions to prevent future events.
7. Provides support to the Patient Care Assessment Program, including assisting in the review and analysis of adverse events by the Program's committee.
8. Provides advice, consultation, and support to hospital administrative and clinical staff, departments, and committees on clinical, regulatory, legal, insurance, risk, and ethical issues.
9. Assists administrative, medical and departmental personnel in the development of policies and procedures that reflect risk management principles.
10. Conducts risk management orientation and continuing education programs for administrative and clinical staff to enhance awareness of their role in patient safety and risk reduction.
11. Collaborates with the patient and family liaisons to promote an environment that supports successful outcomes through timely response to issues and concerns. In collaboration with the patient liaisons, coordinates with department directors and managers and physicians to facilitate resolution of complaints and grievances.
12. Collaborates with the Office of General Counsel attorneys on legal matters when requested.
13. Collaborates with Office of General Counsel and Claims departments in order to review and evaluate claims and other data to identify high-risk activities, procedures, and departments.
14. Works with outside counsel to facilitate timely responses to requests for documents, records, testimony, or other materials.
15. Integrates information identified through risk management program with the credentialing and reappointment process.
16. Participates in regional, state, and national organizations directly concerned with risk management.
17. Provides risk management services to hospital and Physician Organization employees and other clinical and support staff after hours and on weekends and holidays via a rotating on-call schedule.
18. Maintains positive and collaborative relationships with regulatory and oversight agencies and submits appropriate reports and corrective action plans to these oversight agencies as required and appropriate.
19. Complies with all applicable federal and state laws and regulations, the policies and procedures of hospital, and the standards of any relevant accrediting organization; participates actively in and abides by the Compliance standards and HIPPA Programs.
20. Facilitates teamwork and collaboration in an environment of open, effective communication and problem resolution, and fosters a positive work environment.
Physical Requirements:
1. Professional office environment with typical office requirements such as computers, phones, photocopiers, filing cabinets, etc.
2. This is largely a sedentary role, which involves sitting most of the time, but may involve movements such as walking, standing, reaching, ascending / descending stairs and operate office equipment.
3. Frequently required to speak, hear, communicate and exchange information.
4. Able to see and read computers displays, read fine print, and/or normal type size print and distinguish letters, numbers and symbols.
5. Occasionally lift and/or move up to 25 pounds.
Skills & Abilities:
1. Ability to listen, to analyze, to gather additional relevant information, and to use knowledge effectively to solve problems.
2. Ability to present information in an understandable manner in formal and informal settings.
3. Ability to manage multiple priorities.
4. Knowledge of the continuous improvement process and ability to apply it when appropriate.
7. Ability to provide solutions to problems.
8. Ability to recognize safety issues and for appropriate follow-through.
9. Ability to set and accomplish goals.
10. Ability to prioritize and multi-task on-going case load of safety events, grievances, and regulatory reports, with team responsibilities including on-call consults.
At Tufts Medicine, we want every individual to feel valued for the skills and experience they bring. Our compensation philosophy is designed to offer fair, competitive pay that attracts, retains, and motivates highly talented individuals, while rewarding the important work you do every day.
The base pay ranges reflect the minimum qualifications for the role. Individual offers are determined using a comprehensive approach that considers relevant experience, certifications, education, skills, and internal equity to ensure compensation is fair, consistent, and aligned with our business goals.
Beyond base pay, Tufts Medicine provides a comprehensive Total Rewards package that supports your health, financial security, and career growth-one of the many ways we invest in you so you can thrive both at work and outside of it.
Pay Range:
$101,084.26 - $128,878.21