Insurance Risk Manager Jobs in Denver, CO (NOW HIRING)

We are recruiting for a mission-driven Registered Nurse Senior, Clinical Risk Management to join our team!

Our Values

Respect | Belonging | Accountability | Transparency

Department

• Claims Management
  * Review notices of claim, summons and complaints.
  * Perform a detailed claim investigation.
  * Facilitate thorough quality review of claims with either outside reviewers or internal reviewers.
  * Present findings to the Risk Management Committee for disposition of claim recommendations.
  * In conjunction with the Director and General Counsel, recommends a course of action for litigated cases.
  * At the insurance company's request, provide an updated and clinical review of reported occurrences and keep them apprised of claim activity.
  * Maintain case files.
  * Confer directly with claimants, attorneys, physicians, employees, brokers, carriers, and consultants involved in the claim.
  * Assists with interrogatories, depositions, hearings, and trial preparation as necessary.
  * Values claim and assists in settlement negotiations through retained attorneys, mediation or directly with claimant.
  * Act as a resource and liaison for individuals named in a NOC or Summons and Complaint.
  (40%)
• Management of reportable occurrences
  * In collaboration with the Risk Management Director and the department of Patient Safety and Quality, determine whether the occurrence meets the elements for a state reportable event to Colorado Department of Public Health and Environment (CDPHE).
  * Facilitate a thorough review of the occurrence via interviews, chart audits and supporting documentation.
  * Submit final findings to CDPHE along with proposed corrective action items, if applicable.
  (20%)
• Educational Services
  * Provide Risk Management orientation and training for nurses, managers, providers, and others who may be subject to litigation, or as requested.
  * Attend and participate in Morbidity and Mortality (M&M) reviews and department Quality reviews to evaluate discussed cases and assess for significant risk or liability potential.
  * Serve as an active member on risk management/patient safety/quality related committees.
  (10%)
• Management of Sentinel Events
  * In conjunction with the Director, determine if significant occurrences meet the Joint Commission criteria for being considered a sentinel event or near miss.
  * Oversee the Root Cause Analysis (RCA) process.
  * Present the RCA and proposed risk reduction strategies to the appropriate audience.
  (10%)
• Clinical Review of Occurrences
  * When alerted to an occurrence, evaluate the medical practice in relation to professional standards, statutes, regulations, hospital and departmental policies and the standard of care.
  (10%)
• Working with State and Federal Agencies
  * Assist with CDPHE, Joint Commission and CMS surveys.
  * Maintain appropriate records to provide documentation and follow-up as requested.
  * Contact and work with other agencies when necessary, such as Denver Police, if it appears a crime has been committed.
  * Acts as a back-up for the processing of subpoenas when the Legal Secretary is unavailable.
  (5%)
• Interact with defense and claimant attorneys, insurance carriers, brokers and adjusters
  * Promotes positive interpersonal (customer) relationships with fellow employees, physicians, patients and visitors. Treats these individuals with courtesy, dignity, empathy and respect; consistently displays courteous and respectful verbal and non-verbal communications.
  * Adheres to, complies with and demonstrates support for the mission and values of Denver Health. Supports and adheres to the Denver Health Values of Trust, Respect and Excellence.
  * Ensures confidentiality of patient information by creating and maintaining a secure and trusting environment by not sharing information learned on the job, except when necessary in the performance of the job responsibilities or to improve a patient's care.
  * Adheres to Denver Health and departmental attendance guidelines.
  (5%)
Education:
• Bachelor's Degree Required
Work Experience:
• 4-6 years of professional nursing experience in an acute care setting, preferably critical care or emergency medicine. Required and
• 1-3 years of relevant healthcare risk management experience Required and
Licenses:
• RN-Registered Nurse - DORA - Department of Regulatory Agencies Required
Knowledge, Skills and Abilities:
• Demonstrable knowledge and competency in all areas of responsibility as described within this Job Description.
• Such knowledge and competency shall be demonstrated by the ability to:
• Direct independent investigations of risk management matters, report results to stakeholders and assist in development of any necessary corrective action plan
• Develop effective working relationships with management and stakeholders throughout the organization
• Maintain a current working knowledge of federal and state laws and regulations concerning health care risk management
• Effectively educate and train staff with respect to risk management principles
• Demonstrate good judgment, strong analytical skills and excellent interpersonal and writing skills
• Ability to evaluate risk in order to develop and maintain effective risk control processes; and
• Highly self-motivated with the ability to function independently and as part of a team in a fast-paced environment with minimal supervision and direction.

Shift

Work Type

Regular

Salary

$87,700.00 - $135,900.00 / yr

Benefits

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future - with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development - while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you're joining a mission-driven organization that invests in you.

Here is a small list of our benefit programs:

• Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
• 100% paid parental leave up to 6 weeks
• Immediate eligibility for retirement plans with employer contribution up to 9.5%
• Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
• Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
• Free RTD EcoPass (public transportation)
• Childcare discount programs & exclusive perks on large brands, travel, and more
• Tuition reimbursement & assistance
• Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
• Professional clinical advancement program & shared governance
• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

About Denver Health

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, the Public Health Institute at Denver Health, Denver Health Medical Plan and Denver Health Foundation.

As Colorado's primary, and essential, safety-net health care system, Denver Health is a mission-driven organization that has provided millions in uncompensated care for the uninsured each year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Applicants will be considered until the position is filled.