Clinical Risk Manager

0090 Presbyterian System Services; United States; On-site; USD 81,000 - 139,000; Full time

Benefits offered by this job

Comprehensive benefits package

Wellness program

Gift cards and wellness rewards

Job summary

Presbyterian Healthcare Services in Albuquerque, NM seeks a Clinical Risk Manager to lead enterprise risk assessment, incident response, and loss mitigation across the system. This role provides comprehensive healthcare risk management consultation to Presbyterian Healthcare Services (PHS) and collaborates with Legal, Compliance, and Quality/Patient Safety teams.

The position involves regulatory reporting, medical record review, and education to reduce exposure, improve safety, and support

Qualifications

• Bachelor’s degree required.
• Experience in nursing or other clinical field required.
• Five to eight years’ experience in clinical/managerial risk management.
• Proficiency with databases and computer programs.

Responsibilities

• Conduct enterprise risk assessment and program improvement.
• Provide on-site and virtual risk management education and consultation.
• Investigate incidents, guide mitigation actions, and support pre-litigation settlements.
• Support regulatory reporting and compliance activities.
• Review medical records for risk and litigation support.

Skills

Risk management

Healthcare risk

Regulatory compliance

Communication

Education

Bachelor's degree

Tools

Microsoft Office Suite

Claims Management platform

Press Gainey HRP platform

Job description

Location Address: 9521 San Mateo NE Albuquerque, NM 87113-2237

Compensation Pay Range: Minimum Offer $81,432.00 Maximum Offer $138,611.20

Type of Opportunity: Full time

Job Exempt: Yes

Job is based: Reverend Hugh Cooper Administrative Center

Work Shift: Days (United States of America)

Summary

The Presbyterian Health Care Services Clinical Risk Manager supports activities to identify and reduce risk and possibility of monetary losses across the enterprise. This is done through proactive identification of potential areas of risk, responding to actual risk events, providing education to reduce areas of risk, and supporting implementation of risk reduction projects and strategies. This position provides comprehensive healthcare risk management consultation to Presbyterian Healthcare Services (PHS).

Responsibilities

• Enterprise risk assessment & program improvement: Evaluate risk management programs across the delivery system; identify gaps and trends; and recommend policy, workflow, and system changes to reduce exposure and improve loss control.
• Consultation, rounding, and education: Provide on-site and virtual consultative support through site visits, coaching, education, and communication that strengthen risk identification, reporting, resolution, and evaluation processes.
• Event response, investigation, and analysis: Respond to routine and urgent requests from leadership and Legal; direct and obtain preliminary investigative information; determine initial liability exposure; and guide mitigation actions and corrective plans.
• Claims, complaints, and pre-litigation resolution: Investigate incidents involving actual or potential injury to patients, visitors, and employees; manage potentially compensable events and required carrier notifications; collaborate with attorneys/adjusters; and support timely pre-litigation settlements within delegated authority.
• Regulatory, accreditation, and agency reporting: Maintain current knowledge of applicable regulatory and accreditation standards; ensure compliance with reporting requirements (including to the NM Health Care Authority and other agencies as required); and support investigations and corrective action planning.
• Clinical documentation and medical record review: Perform detailed medical record reviews, timelines, and summaries to support claim resolution and anticipated litigation; and assist with subpoenas, board/regulatory/insurance inquiries, and policy compliance reviews.
• Cross-functional partnership: Serve as a clinical risk management resource and educator for Legal, Compliance, Quality/Patient Safety, Patient Relations, Privacy, and operational leaders; answer emergent/urgent inquiries from clinical workforce and providers.
• Support Privacy investigations; and partner with Compliance investigating hotline complaints and documentation/billing concerns.
• Committee and governance participation: Actively participate in quality and patient safety initiatives and related committees across the Presbyterian Delivery System; contribute to quarterly internal/external counsel claim reviews and reserve-setting activities.
• Reporting and communication: Provide periodic reports to the Director, administration, and Boards regarding sentinel events, trends, and action plans; develop and deliver routine and ad hoc education on risk management and loss mitigation.
• Special investigations (as directed by Legal): In collaboration with and at the direction of Legal: Complete detailed medical record reviews, timelines, and summaries to support investigations and Legal review (e.g., potential EMTALA concerns, complex discharges, and clinical diagnosis/treatment questions).
• Validate documentation of the patient’s identified decision-maker and authority (e.g., guardianship, medical or durable power of attorney) and supporting records relevant to decision-making for incapacitated patients.
• Support subpoenas and external inquiries by reviewing medical record documentation, staff assignments, and patient care issues for Medical/Nursing/Ancillary boards, regulatory agencies, insurers, and other investigative bodies.
• Analyze and interpret complaints, unanticipated events, and other data related to medical staff, nursing, and ancillary personnel to support employment and/or Medical Staff Affairs reviews and investigations.
• Provide medical record reviews and supporting content for Medical Ethics consultations; state/federal inquiries; policy compliance reviews; and evaluation of patient care outcomes.
• Conduct investigations related to allegations of workforce to patient allegations of abuse, neglect, or exploitation.

Qualifications

• Bachelor’s degree required.
• Experience in nursing or other clinical field required.
• Five to eight years’ experience in the clinical/managerial arena with involvement in risk management activities required.
• Proficiency in database and other computer programs desired.

Detailed Responsibilities Competencies

• Planning and coordinating organizational change.
• Anticipating & Addressing Customer Needs.
• Functioning as an Effective Contingent Member.
• Acquiring & Applying Superior Skills to achieve Quality Outcomes.
• Functioning as an Effective Team Member in assisting Legal, Compliance, and Risk Management, and Patient Relations.

Skills

• SKILL-Ability to effectively interact with customers to understand their needs and explain data.
• SKILL-Microsoft Office Suite; Claims Management platform, Press Gainey HRP platform.
• SKILL-Strong interpersonal and negotiation skills.
• SKILL – Influence change and work to outcomes to improve quality of care to members and patients.
• SKILL-Demonstrated ability to communicate effectively in person and via telephone with members, employer groups, brokers, attorneys, insurance adjusters, physicians, and physician office staff using strong dialogue and customer service competencies.
• SKILL-Effective and persuasive written and oral communication.

Benefits

• All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
• Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being.
• Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED.

PHS is a drug-free and tobacco-free employer with smoke-free campuses.

We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services Here, we’re committed to a different way to make a difference. Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, nurses, employees, board members, and volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than one in three New Mexicans. We are part of New Mexico's history and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.