Clinical Risk & Claims Specialist I

Memorial Hermann Health System; Houston (TX); On-site; USD 110,000 - 140,000; Full time

Job summary

Memorial Hermann Health System is seeking an experienced Clinical Risk Manager to oversee a portfolio of hospital-based claims. You will lead investigations, review medical records, assess liability and standard of care issues, and collaborate with risk management attorneys, outside counsel, and facility risk managers to resolve claims.

You will provide clinical risk management education to drive loss prevention, quality, and patient safety initiatives across the enterprise, while modeling

Qualifications

• Bachelor's Degree in Nursing (preferred).
• CPHRM designation or eligible within 3 years.
• 5+ years clinical hospital experience.
• 3+ years risk management in hospital or nurse paralegal in a law firm.
• Strong curriculum development and delivery skills.
• Ability to collaborate with health professionals at all levels.
• Proficient computer skills.
• Strong interpersonal, organizational, and communication skills.

Responsibilities

• Manage a portfolio of claims assigned.
• Investigate claims and review medical records; assess liability.
• Evaluate standard of care issues and timelines.
• Communicate with claimants, families, and counsel to resolve claims.
• Liaise with outside counsel in development and resolution of claims.
• Represent the organization in mediations or trials as needed.
• Provide clinical risk management guidance to facility Risk Managers.
• Monitor claims trends to support loss prevention initiatives.
• Participate in enterprise clinical risk assessments with other areas.
• Collaborate with loss prevention, quality and patient safety on risk education.
• Ensure safe care and adherence to Memorial Hermann policies within budget and resources.
• Serve as preceptor/mentor to staff.

Skills

Clinical education

Curriculum development

Communication skills

Interpersonal skills

Collaboration

Computer proficiency

Education

Bachelor's degree in Nursing

CPHRM designation

Job description

Memorial Hermann Health System is seeking an experienced Clinical Risk Manager to oversee a portfolio of hospital-based claims. You will lead investigations, review medical records, assess liability and standard of care issues, and collaborate with risk management attorneys, outside counsel, and facility risk managers to resolve claims.

You will provide clinical risk management education to drive loss prevention, quality, and patient safety initiatives across the enterprise, while modeling