Insurance Risk Manager Jobs in Eden, WI (NOW HIRING)

• This role requires a primarily 1st shift onsite presence at our Aurora Medical Center West Allis - 8901 W Lincoln Ave facility.

• This role has on call responsibilities

Pay Range

Major Responsibilities:

• Utilizes a proactive risk management approach that relates to an enterprise scope of practice Establishes relationships with site executive and medical staff leadership to identify and facilitate development and resolution of system and site risk identification and reduction measures. Oversees the development of site risk management programs, ensuring standard assessment and measures. Supports appropriate risk management coverage within site.

• Addresses health outcomes, risk identification, loss prevention, and claims management to improve the quality of patient care; prevent, mitigate and/or reduce risk of potential and actual financial, physical and reputational loss at assigned sites. Participates in site health outcomes goals and strategic plan development, implementation and measurement including provision of data and recommendation within the site. Participates in site level safety huddles; participate in weekly risk huddles. Identifies, in conjunction with site and other departments, high risk areas requiring proactive risk assessments.

• Coordinates resources to achieve review, findings and action plan. Presents results to applicable groups. Develops goals and plans through multiple internal data sources including the complaint and event reporting system, claims, write-offs, risk and quality assessments, recalls; and external sources such as literature evidence based practice, and alerts from national and international sources. Shares quarterly site-based Risk Management reports with appropriate groups. Develops educational programs for site and departments addressing risk management issues, outcomes, and topics.

• Manages assigned site Risk Management roles, processes responsibilities in regard to claims management and the insurance program. Reviews, analyzes, and develops improvement actions based on claims loss runs. Submits site and physician exposure data for the annual insurance renewal.

• Maintains site adverse event reporting, investigation, and resolution process. Participates in web-based reporting design, access, training and implementation. Reviews and tracks reported events. Maintains and improves process to identify significant events and notify appropriate system and site executives, claims, patient safety, legal, compliance, safety/security, and media relations. Facilitates patient disclosure meetings. Tracks, trend, analyzes data to mitigate, reduce or eliminate harm and/or liability issues. Works with public safety/security to identify, mitigate and prevent safety issues and exposure for the organization, including teammates and visitors.

• Acts as the site risk expert and resource for medical/legal inquiries of physicians, nurses, administrators, and others regarding emergent patient care issues and loss control, in conjunction with Legal Counsel; for policy and procedure development, including event reporting, consent, and disclosure policies; for applicable contract review.

• Works with site, and if needed other sites, to address patient complaints and grievances. Ensures regulatory compliance and appropriate responses. Ensures referral, review and response of patient complaints with significant quality or service concerns. Involves language services and civil rights departments as needed. Tracks and trend complaints and grievances, identifying risk or liability issues.

• Works collaboratively with Legal and Compliance on site issues, contracts, regulatory and accreditation issues, operational and policy issues, governmental, litigation and other relevant issues.

• Keeps management informed of site-based issues; coordinate communication to site from system.

Licensure, Registration, and/or Certification Required:

• Certified Professional in Patient Safety (CPPS) designation issued by the Certification Board for Professionals in Patient Safety (CBPPS) needs to be obtained within 1 year, or

• Certified Professional in Health Care Risk Management designation issued by the American Hospital Association (AHA) needs to be obtained within 1 year.

Education Required:

• Bachelor's Degree in Health Care Administration or related field.

Experience Required:

• Typically requires 7 years of experience in in system healthcare setting, experience with risk management, patient safety and quality.

Preferred:

• Clinical experience

• Medical records review using Epic

• Origami system experience

Knowledge, Skills & Abilities Required:

• Proficient in Microsoft Office (Excel, Word, PowerPoint, Access) or similar products.

• Ability to guide and mentor physicians, including disruptive behavior and in situations where failure to follow policy is not an option.

• Strong decision-making and critical thinking skills.

• Significant successful high-level interaction with medical staff.

• Strong skills in successfully managing multiple units.

• Strong skills in diplomacy and conflict resolution at various levels within the organization.

• Strong aptitude in human resource management.

• Ability to handle multiple demands simultaneously.

• Excellent communication skills (oral and written, group and one-on-one).

• Extensive knowledge of statistical methods, data analysis and presentation.

Physical Requirements and Working Conditions:

• Frequently lifts up to 10 lbs. and occasionally lifts over 100 lbs. with assistance.

• Must be able to sit 50% of the workday and stand 35%.

• Must have clear speech, hearing and vision.

• Will be exposed to mechanical, electrical and chemical hazards.

• Must wear protective clothing (i.e., lead aprons, isolation gowns, protective eyewear, etc.) as needed.

• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our CommitmenttoYou:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training

• Premium pay such as shift, on call, and more based on a teammate's job

• Incentive pay for select positions

• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs

• Health and welfare benefits such as medical, dental, vision, life, andShort- and Long-Term Disability

• Flexible Spending Accounts for eligible health care and dependent care expenses

• Family benefits such as adoption assistance and paid parental leave

• Defined contribution retirement plans with employer match and other financial wellness programs

• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.