Insurance Risk Manager Jobs in Dallas, TX (NOW HIRING)

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

• We serve faithfully by doing what's right with a joyful heart.
• We never settle by constantly striving for better.
• We are in it together by supporting one another and those we serve.
• We make an impact by taking initiative and delivering exceptional experience.

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level.

This position will support BSWH Waxahachie Medical Center and Health Texas Provider Network (HTPN) Clinics. The primary home office for this position will be in the Waxahachie hospital with travel to the HTPN Clinics when expected.

The Clinical Risk Manager (CRM) directs and coordinates clinical risk management for the hospital. The CRM integrates information from adverse events, near misses, RCAs, and clinical risk issues. With this information, the CRM reviews findings and works with Patient Safety and hospital managers. Together, they develop programs to improve a culture that supports patient safety and reduces risk exposure.

• Reviews SSOS reports and obtains more detailed information by chart review and interviews as indicated.
• When adverse events harm patients, the CRM, led by the Corporate Director of Risk Management, investigates to evaluate patient harm. If organizational risk is found, the Corporate claims manager will review the event further. The CRM will help conclude on early intervention.
• Addresses daily questions and problems about patient care or concerns. Addresses patient complaints or incidents. Works to resolve issues before they become liability claims.
• Receives information from team members who manage complaints and the Ethics Hotline about patient care processes that may cause harm. The CRM will help team members address or resolve complaints and Ethics Hotline reports.
• Addresses grievances involving patient care and responds within the CMS-designated time frame. Provides follow-up communication when the complaint is resolved.
• Is a trusted agent for clinical staff to report concerns about aspects of care that may generate risk to patients.
• Participates in disclosing adverse events to patients and families. Serves as a consultant and educator to those responsible for disclosure.
• Reports to BSWH department of Risk Management and facility senior clinical and executive managers: a) the initial existence of serious adverse events, concerns, or risks and the investigation plan; b) the results of the initial investigation; c) the plan for a more detailed investigation (RCA or other); d) the 'lessons learned' from studying the event.
• Assists the Manager of Insurance in managing claims related to property loss and visitor injury.
• Clinical Risk Study and Priority setting that is based upon priorities and specific hospital performance.
• Studies trends of adverse events from SSOS or other electronic data sources. Presents results to the Hospital PS Committee, senior clinical and executive managers, and governance groups when asked.
• Investigates and prepares for the root cause study of sentinel events. This includes developing a timeline and contacting required participants. Establish attendance, schedule, and participate in the meeting. Write the investigation report. Schedule a follow-up corrective action plan and monitor the plan. Report sentinel events to corporate risk management monthly.
• Participates in the multidisciplinary adverse event review team that meets regularly to discuss adverse event reports of E or greater.
• Regularly reports to executive and medical staff managers related to CRM trending data and 'lessons learned'.
• Develops and presents education programs for personnel. These programs increase awareness of their role in reducing medical errors. This helps prevent patient injury and lowers liability risk.

• Bachelor's Degree in a healthcare field and four years of clinical experience. Or, an Associate's Degree in a healthcare field and six years of clinical experience. Or, an RN with less than a Bachelor's Degree and six years of clinical experience.
• TX RN license if an RN
• Certified Professional in Healthcare Risk Management (CPHRM) preferred.

We believe that all people should feel welcomed, valued and supported.

QUALIFICATIONS

• EDUCATION - Associate's
• EXPERIENCE - Less than 1 Year of Experience