Clinical Risk Management Manager

Foundation-Risk-Partners; Edison (NJ); On-site; USD 100,000 - 125,000; Full time

Benefits offered by this job

Health benefits

401(k) match

Paid time off (PTO)

Life insurance

Job summary

Foundation-Risk-Partners is seeking a Clinical Risk Management Consultant to identify, assess, and mitigate clinical risks for healthcare providers within an insurance brokerage environment. You will review medical records, analyze claims, and work with underwriters to tailor coverage based on risk factors.

The role involves developing risk-management trainings, ensuring regulatory compliance, and advising clients on best practices to minimize claims and legal exposure.

Responsibilities

• Review medical records, incident reports, and claims data to identify potential clinical risks associated with patient care, including medication errors, standard of care compliance risks, and diagnostic errors
• Detect and manage risk exposure
• Maintain and update an organization's policies
• Improve documentation practices
• Seek ways to reduce the legal exposure of the organization
• Create and maintain risk audit databases
• Identify for clients’ ways to take the steps needed to prevent data breaches
• Investigate any events that result in death or injuries
• Analyze clinical data to identify trends and patterns of risk within a healthcare provider's practice, allowing for proactive risk mitigation strategies
• Advise clients on clinical best practices, quality improvement initiatives, and risk reduction strategies to minimize potential claims
• Evaluate clinical aspects of claims, including medical necessity and appropriateness of treatment, to identify areas for improvement and potential cost savings
• Collaborate with underwriters to assess clinical risk profiles of healthcare providers, informing coverage recommendations and premium calculations
• Develop and deliver clinical risk management training programs for healthcare providers, including staff on topics like informed consent, documentation best practices, and patient safety
• Stay updated on relevant healthcare regulations and industry standards to ensure clients are adhering to appropriate clinical risk management practices

Job description

The Clinical Risk Management Consultant is focused on identifying, assessing, and mitigating clinical risks for healthcare providers within an insurance brokerage firm, utilizing their medical expertise to analyze potential claims, advise clients on risk reduction strategies, and work with underwriters to secure appropriate coverage based on clinical risk factors.

Essential Functions:

• Clinical Risk Assessment:
  • Review medical records, incident reports, and claims data to identify potential clinical risks associated with patient care, including medication errors, standard of care compliance risks, and diagnostic errors.
  • Detect and manage risk exposure
  • Maintain and update an organization's policies
  • Improve documentation practices
  • Seek ways to reduce the legal exposure of the organization
  • Create and maintain risk audit databases
  • Identify for clients’ ways to take the steps needed to prevent data breaches
  • Investigate any events that result in death or injuries
• Trend Analysis:
  • Analyze clinical data to identify trends and patterns of risk within a healthcare provider's practice, allowing for proactive risk mitigation strategies.
• Advise clients on clinical best practices, quality improvement initiatives, and risk reduction strategies to minimize potential claims.
• Claims Review and Analysis:
  • Evaluate clinical aspects of claims, including medical necessity and appropriateness of treatment, to identify areas for improvement and potential cost savings.
• Collaborate with underwriters to assess clinical risk profiles of healthcare providers, informing coverage recommendations and premium calculations.
• Education and Training:
  • Develop and deliver clinical risk management training programs for healthcare providers, including staff on topics like informed consent, documentation best practices, and patient safety.
• Regulatory Compliance:
  • Stay updated on relevant healthcare regulations and industry standards to ensure clients are adhering to appropriate clinical risk management practices.

Note: The specific responsibilities of an insurance broker clinical risk management role may vary depending on the size and focus of the brokerage firm, as well as the healthcare provider clientele they serve.

This range represents the estimated low and high end of the salary range for this position. Actual salaries will vary and may be above or below the range based on factors including but not limited to performance, location, and experience. The range listed is just one component of FRP's total compensation package for employees.

Pay Transparency Range

$100,000 - $125,000 USD

Disclaimer:

While this job description is intended to be an accurate reflection of the job requirements, management reserves the right to modify, add, or remove duties from particular jobs and to assign other duties as necessary.

Equal Employment Opportunity (EEO):

FRP provides equal employment opportunity to qualified persons regardless of race, color, sex, religion, national origin, age, sexual orientation, gender identity, disability, veteran status, or any other classifications protected by law.

FRP offers a comprehensive range of health-related benefit options including medical, vision, and dental. We offer a 401(k) with company match, company paid life insurance, STD, LTD and a generous PTO policy starting at 18 days per year plus 10 paid holidays & 2 floating holidays!