Insurance Risk Manager Jobs in Greenville, NC (NOW HIRING)

Company Overview

Contentnea Health is a Community Health Center providing comprehensive medical, dental and behavioral health services for members of our communities in Greene, Pitt and Pamlico counties in eastern North Carolina. 

Job Summary  
Leads the risk management initiatives of the organization and ensures compliance with regulatory requirements.
Responsibilities and Duties

1. Manages the organization’s Risk Management program.

1. Administers the organization’s emergency management and  safety plans. Serves as the point of contact for external community partners (i.e. Fire, County Emergency Management, etc.).
2. Performs and communicates the results of internal safety/compliance audits  and identifies training needs based on these results.
3. Provides support for risk management meetings and presentations.
4. Assists and provides guidance to staff with risk management, safety, and compliance projects.
5. Develops, monitors, and evaluates the effective implementation of the organization’s Risk and Safety Programs.
6. Facilitates a culture of safety in the organization that creates an atmosphere of mutual trust for staff to talk about safety concerns and solutions.
7. Compiles and summarizes program activities into reports for the Board of Directors and executive leadership.
8. Maintains and updates all required regulatory forms, patient notices, and clinic signage to comply with federal, state and local guidelines.
9. Manages and maintains confidential information and records in accordance with HIPAA and organizational policies.

1. Ensures compliance with internal initiatives and external regulatory requirements.

1. Identifies potential risks by analyzing data, observing processes, and communications with staff.
2. Collaborates with the Quality Improvement (QI) Department for projects and initiatives.
3. Safeguards the organization from liability with current incentive, regulatory, and certification requirements (such as Patient Centered Medical Home (PCMH), Federal Tort Claims Act (FTCA) and Uniform Data System (UDS) through documentation, participation in initiatives, and other activities as directed.
4. Creates and generates routine and ad hoc reports as needed to support risk management activities.
5. Assists in the establishment and monitoring of information privacy policies and procedures in coordination with management to ensure HIPAA compliance.
6. Ensures proper reporting of violations or potential violations to internal management as appropriate, and duly authorized external enforcement agencies as required.

1. Manages patient complaints and grievances.
   1. Reviews patient feedback, complaints, and grievance reports and facilitates resolution through consultation or assignment to the appropriate party.
   2. Tracks  resolution of complaints and grievances.
   3. Works directly with the health center’s legal team as needed to manage complaints to clinical oversight agencies such as the NC Medical Board, NC Board of Nursing, and NC Board of Dental Examiners.

1. Manages environment of care and emergency preparedness assessments.
   1. Manages and investigates Occupational Safety and Health Administration (OSHA) claims.
   2. Leads environmental safety tours.
   3. Recommends revisions for emergency plans based on operational and compliance needs.
   4. Coordinates and oversees emergency drills twice a year.
   5. Conducts Fire Drills and prepares After Action Reports.
   6. Coordinates fire marshal inspections every three years.
   7. Conducts fire extinguisher inspections annually.

1. Assesses patient events and near-misses.
   1. Reviews and analyzes patient incidents and near-miss reports.
   2. Coordinates action plans to address patient safety incidents in consultation with leadership.
   3. Determines training needs of the organization based on findings and collaborates with leaders to develop training plan.

Qualifications and Skills

• Possesses advanced general skills, including written and verbal communications skills, computational and computer skills, and mathematical knowledge frequently acquired through completion of a general Bachelor’s Degree program or Associate’s Degree with acquired business experience.
• Possesses knowledge of healthcare regulations and standards, including HIPAA, OSHA, CMS, HRSA and other federal/state regulatory requirements.
• Possesses knowledge of risk assessment and mitigation strategies, incident reporting systems, and root cause analysis (RCA).
• Possesses understanding of insurance claims, liability management, and legal terminology as it relates to healthcare risk.
• Previous risk management experience in a healthcare setting is preferred.

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