Insurance Risk Manager Jobs in La Grange, KY (NOW HIRING)

At SCA Health, we believe health care is about people – the patients we serve, the physicians we support and the teammates who push us forward. Behind every successful facility, procedure or innovation is a team of 15,000+ professionals working together, learning from each other and living out the mission, vision and values that define our organization. 

As part of Optum, SCA Health is redefining specialty care by developing more accessible, patient-centered practice solutions for a network of more than 370 ambulatory surgical centers, over 400 specialty physician practice clinics and numerous labs and surgical hospitals. Our work spans a broad spectrum of services, all designed to support physicians, health systems and employers in delivering efficient, value-based care to patients without compromising quality or autonomy.  

What sets SCA Health apart isn’t just what we do, it’s how we do it. Each decision we make is rooted in seven core values: 

• Clinical quality 
• Integrity 
• Service excellence 
• Teamwork 
• Accountability 
• Continuous improvement 
• Inclusion 

Our values aren’t empty words – they inform our attitudes, actions and culture. At SCA Health, your work directly impacts patients, physicians and communities. Here, you’ll find opportunities to build your career alongside a team that values your expertise, invests in your success, and shares a common mission to care for patients, serve physicians and improve health care in America.    

At SCA Health, we offer a comprehensive benefits package to support your health, well-being, and financial future. Our offerings include medical, dental, and vision coverage, 401k plan with company match, paid time off, life and disability insurance, and more. Please visit, https://careers.sca.health/why-sca, to learn more about our benefits.

Your ideas should inspire change. If you join our team, they will. 

Lead, facilitate, and advise the Center Quality Council and internal performance improvement teams:

• Set the agenda and maintain meeting minutes
• Ensure reporting of all mandatory and center specific monthly and quarterly reports for trends/areas for improvement to the Quality Council and Medical Executive Committee/Governing Body a minimum of quarterly:
  • Medical Record Audit reports; Monthly or quarterly data collection from ongoing systematic chart review to assess quality of documentation.
  • Infection Control reports
  • Hospital Transfer/Complication reports
  • Patient Safety; measurement of key measures of patient safety and hazard analysis/process redesign (adverse events, root cause analysis).
  • Life safety (environment of care); Provide for a detailed assessment and evaluation of the Environment of Care (EOC) and the associated conditions, staff education and readiness and the various processes. Framework for the EOC includes the management processes and systems that affect safety, security, hazardous materials, emergency preparedness, life safety, medical equipment, and utilities management.
  • Risk Management (incident reporting)
  • Adverse Drug Reaction reports
  • Cancellation logs
  • Service Satisfaction reports (patients, staff and physicians)
  • Center specific quality indicator reports as appropriate
  • PI reports; Collection, analysis and summary of performance improvement data.

Provides strategic oversight of proactive and reactive patient safety activities:

• Root cause analysis.
• Clinical practice guidelines
• Sentinel Event Alerts
• Identification and data collection of center specific quality indicators based on high risk, problem prone procedures as appropriate.
• Review and revision of the PI Plan on an annual basis and preparation of the annual report of the PI program to the Medical Executive Committee/Governing Body.
• Documentation of all Performance Improvement activities and maintenance of records for a minimum of three years.

Provides strategic oversight of proactive and reactive patient safety activities (continued):

• Coordination of the center policies/procedures and processes to be in compliance with the current standards of applicable regulatory and accrediting agencies, and mandatory SCA Corporate policies.
• Working with the Administrator/designee to ensure currency of all physician files, medical staff appointments and/or privileges and compliance with credentialing policies and procedures. Coordinating as appropriate the peer review process and aggregate individual peer review data for presentation and review by the Medical Executive Committee and Governing Body at reappointment.
• Working with the Administrator/designee to ensure currency and completeness of all human resource and education files for center employees and contract personnel. 

Maintain Center Survey readiness:

• Assess center compliance with accreditation standards and regulations in collaboration with leadership and staff.
• Identify areas of vulnerability and direct the development of strategies to enhance compliance.
• Provide the overall direction necessary to ensure that clinical services provided are evidence-based, in accordance with standards established through state and federal regulations and applicable accreditation standards, including the National Patient Safety Goals.

Communicate Effectively Throughout All Levels of the Organization:

• Proactively educate and train the leadership and staff regarding regulatory issues, new statutes/guidelines, and safety/quality/performance improvement activities and their respective responsibilities in carrying out the performance improvement program.

• Maintain effective communication on current center activities related to Safety/Quality/PI and Accreditation and seek consultation as needed for support from the Regional Quality Coordinator or assigned Group Director. 

Other duties as assigned by Center Administrator.

Licenses or Certifications: Licensed Registered Nurse

Education, vocational training, and experience:  

• Registered Nurse with training and experience in quality/performance improvement and accreditation and regulatory standards.
• Minimum of an Associate’s degree in nursing, Bachelor’s degree preferred
• Work in concert with the Regional Quality Coordinator to implement the SCA strategic clinical-quality plan.
• Possess excellent written and oral communication skills.
• Knowledge of standards, survey methodology and related tools and resources for regulatory and accreditation requirements
• Regularly accesses internal and external resources to maintain professional knowledge base.

Licenses or Certifications: Licensed Registered Nurse

Education, vocational training, and experience:  

• Registered Nurse with training and experience in quality/performance improvement and accreditation and regulatory standards.
• Minimum of an Associate’s degree in nursing, Bachelor’s degree preferred
• Work in concert with the Regional Quality Coordinator to implement the SCA strategic clinical-quality plan.
• Possess excellent written and oral communication skills.
• Knowledge of standards, survey methodology and related tools and resources for regulatory and accreditation requirements
• Regularly accesses internal and external resources to maintain professional knowledge base.