Clinical Risk & Claims Specialist I

Memorialhermann; Houston (TX); On-site; USD 120,000 - 180,000; Full time

Job summary

Memorial Hermann is seeking a Clinical Risk Manager to oversee a portfolio of hospital-based claims, lead investigations, and provide expert risk management guidance. You will collaborate with risk management attorneys, outside counsel, and facility-based risk managers to improve quality of care and safety.

The role emphasizes clinical risk education, loss prevention, and timely resolution of claims in a high-stakes healthcare setting. A nursing background with CP... (truncated in source)

Qualifications

• Education: Bachelor’s Degree in Nursing preferred.
• CPHRM designation or obtain within three (3) years.
• 5+ years of progressive clinical experience in a hospital setting.
• 3+ years in risk management in hospital-based env. or as a nurse paralegal in a law firm.
• Ability to develop and deliver clinical education curriculum.

Responsibilities

• Manage a portfolio of claims as assigned and oversee investigations.
• Review medical records, formulate chart summaries and timelines, assess liability and standard of care.
• Resolve claims through communications with claimants, families and counsel.
• Act as liaison with outside counsel and participate in mediations or trials as needed.
• Provide risk management education and support to facilities system-wide.
• Support system risk management on-call duties and loss prevention initiatives.
• Monitor clinical risk trends and recommend mitigation strategies.
• Collaborate in enterprise clinical risk assessments with other functions.

Skills

Curriculum development

Team collaboration

Computer literacy

Interpersonal skills

Organizational skills

Communication skills

Education

Bachelor's in Nursing

CPHRM certification

Tools

RMIS

Variance reporting

Job description

Memorial Hermann is seeking a Clinical Risk Manager to oversee a portfolio of hospital-based claims, lead investigations, and provide expert risk management guidance. You will collaborate with risk management attorneys, outside counsel, and facility-based risk managers to improve quality of care and safety.

The role emphasizes clinical risk education, loss prevention, and timely resolution of claims in a high-stakes healthcare setting. A nursing background with CP... (truncated in source)