Director, Clinical Claims & Risk Management

Health First; Florida; On-site; USD 120,000 - 180,000; Full time

Job summary

Health First in Florida seeks a Director, Claims Management to oversee investigation, evaluation and resolution of medical, professional, and general liability claims, applying clinical judgment in line with Health First’s guidelines and best practices.

You will lead collaboration with outside counsel, inform reserve decisions, manage reporting, audits, and trend analysis to support clinical risk management and patient safety initiatives.

Qualifications

• Clinical expertise required, nursing background or clinical risk management experience.
• Understanding of hospital operations, medical charts, clinical terminology; strong communication and business skills.

Responsibilities

• Oversee investigation, evaluation and resolution of medical, professional, and general liability claims.
• Collaborate with outside counsel and Claims Reserve Committee to develop strategic frameworks for claim resolution.
• Manage claims reporting requirements, audits, and analyze trending information to support risk management and patient safety initiatives.

Skills

Clinical risk management

Nursing background

Hospital operations

Communication skills

Education

Bachelor's degree in Risk Management, Legal Studies, Nursing (BSN)

Master's degree in Legal Studies, Risk Management, Nursing or Juris Doctor (JD)

RN licensure in Florida

Tools

AIC

CPHRM

ARM

Paralegal Certification

Job description

Health First in Florida seeks a Director, Claims Management to oversee investigation, evaluation and resolution of medical, professional, and general liability claims, applying clinical judgment in line with Health First’s guidelines and best practices.

You will lead collaboration with outside counsel, inform reserve decisions, manage reporting, audits, and trend analysis to support clinical risk management and patient safety initiatives.