Insurance Risk Manager Jobs in Eugene, OR (NOW HIRING)

Description

PeaceHealth is seeking a Clinical Risk Manager Sr for a Full Time, 1.00 FTE, Day position. The salary range for this job opening at PeaceHealth is $50.89 – $76.33. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.

Job Summary

The Senior Clinical Risk Manager leads the investigation and management of complex, high-severity risk events across the healthcare system. Provides strategic leadership and oversight in the identification, evaluation, and mitigation of clinical risks for their assigned areas. This role provides expert-level consultation on clinical risk, supports regulatory compliance, and leading enterprise-wide initiatives to enhance patient safety and reduce liability. In addition, this role is responsible for mentoring and supporting our clinical risk managers. The Senior Clinical Risk Manager collaborates with executive leadership, legal counsel, and clinical teams to drive a proactive risk management culture and ensure compliance with regulatory standards.

Essential Functions

• Leads the identification and investigation of high-severity risk events, including coordination with legal, patient safety, compliance, and executive leadership. Collaborates with legal counsel on complex claims and litigation support.

• Oversees and guides Root Cause Analyses (RCAs), Failure Mode and Effects Analyses (FMEAs), Apparent Cause Analysis, and other risk assessments. Leads proactive risk assessments for high-risk areas.

• Serves as a senior advisor to clinical and operational leaders on risk mitigation strategies and patient safety initiatives. Develops and communicates with senior management on appropriate responses to risk events and medical care complaints in accordance with legal requirements.

• Develops and implements system-wide risk management standard work, protocols, and policies. Leads the development and delivery of advanced risk management education and training. Provides mentorship, training, and support for clinical risk managers.

• Analyzes system-wide trends in incident reporting, tracks key performance indicators, and develops strategic recommendations for improvement. Regularly provides leadership with progress reports and data (including recommendations) related to risk management. Provides leadership of performance improvement and loss prevention activities.

• Represents the Risk Management department on committees and task forces focusing on high-risk issues.

• Investigates alleged EMTALA violations. Ensures that applicable regulatory and accreditation requirements are met in a proactive manner. Participates in development of processes/systems designed to share and recognize performance improvements and compliance across the organization to mitigate risks to patient and caregiver safety/risks to the organization.

• Facilitates teams related to system-wide approaches for risk mitigation. Supports skills and competency development in risk management for community-based resources. With system team, designs training curriculum, develop program content and provide education to leadership teams, quality leaders, supervisor other caregivers/providers.

• Serves as system subject matter expert for risk mitigation strategies on high-risk topics such as OB, ED, ICU and Behavioral Health service lines or Informed Consent, Use of Force oversight, Laser Safety, Medical Device Reporting, Adoptions and other topics.

• Assists Patient Relations to address complex grievances that involve patient care and responds to the patient in the time frame designated by policy.

• In partnership with the Quality department, leads the organization’s regulatory response in the event of a formal patient complaint or EMTALA survey and corrective action plan.

• Serves as the lead for the communication & resolution program (disclosure process) in assigned areas of responsibility.

• Monitors and interprets changes in healthcare regulations and proactively adjusts risk strategies to maintain compliance.

• Serves as the non-discrimination officer for their assigned areas of responsibility.

• Performs other duties as assigned.

Qualifications

Education

• Bachelor's Degree Required: in Nursing or other clinical field and

• Master's Degree Preferred: in nursing, healthcare administration, public health or related field

Experience

• Minimum of 5 years Required: Healthcare risk management, compliance, quality improvement or patient safety or

• Minimum of 5 years Required: Combination of directly related clinical experience AND risk management, compliance, quality improvement, or patient safety

Credentials

• Required: RN, or license clinical discipline (RN preferred) in OR, WA, or AK and

• Required: within 2 years Certified Professional Healthcare Risk Management

Skills

• Advanced knowledge of state, federal, and accreditation requirements including but not limited to: CMS Conditions of Participation for acute care and critical access hospitals. (Required)

• General knowledge in other regulatory areas such as, OSHA, EMTALA, and HIPPA. (Required)

• State healthcare rules and statutes, and state licensing requirements. (Required)

• Proficient with MS Office applications. (Required)

• Excellent communication, interpersonal, collaboration, and presentation skills. (Required)

• Advanced analytical and problem-solving skills. (Required)

• Ability to lead and motivate teams, influence others, and drive change. (Required)

• Able to work flexible hours. (Required)

• Participation in on-call coverage. (Required)

Working Conditions

Lifting

• Consistently operates computer and other office equipment.

• Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.

• Sedentary work.

Environmental Conditions

• Predominantly operates in an office environment.

• Some time spent on site in medical/hospital setting.

Mental/Visual

• Ability to communicate and exchange accurate information.

• The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.

PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility.

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.