Manager of Risk Management Operations

adventhealth; La Grange (IL); On-site; USD 83,000 - 155,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Paid Time Off from Day One

403-B Retirement Plan

Parental Leave (4 weeks)

Career Development

Well-being Resources

Mental Health Resources

Pet Benefits

Job summary

AdventHealth is seeking a Risk Management professional to support lawsuits, claims and PCEs, and to perform medical records reviews and HFACS-RCA2 analyses for defense. You will initiate claim files, secure documents, and coordinate with outside attorneys.

The role includes developing regional risk-reduction strategies, guiding grievance resolutions, and leading annual initiatives to reduce claims costs for hospitals and clinics. RMIS oversight and insurance coordination are also involved.

Qualifications

• Bachelor's degree required.
• Minimum 2+ years of Risk Management, Quality and Patient Safety experience.
• CPHRM certification preferred or equivalent experience.

Responsibilities

• Support risk management and outside attorneys in lawsuits and PCEs.
• Perform medical records review and HFACS-RCA2 reviews for defense preparation.
• Initiate claim files, secure documents and manage discovery requests.
• Coordinate with Claims Manager and outside attorneys.
• Develop risk reduction strategies for the region and assist grievance resolution.
• Provide leadership to regional initiatives to reduce claims costs for hospitals/clinics.
• Oversee RMIS guidelines for incident scoring and data access.
• Assist with procurement and maintenance of insurance coverage; issue Certificates of Coverage.

Skills

Insurance knowledge

Workers’ compensation

GL claims management

Hospital reporting requirements

Risk Management

Quality and Patient Safety

Education

Bachelor's degree

Job description

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
• Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Career Development
• Whole Person Well-being Resources
• Mental Health Resources and Support
• Pet Benefits

Schedule:

Full time

Shift:

Day (United States of America)

Address:

6061 S Willow Dr

City:

Greenwood Village

State:

Colorado

Postal Code:

80111

Job Description:

• Provides support to AdventHealth Corporate Services Risk Management and outside attorneys for lawsuits, claims and Potential Compensable Events (PCEs) in preparation and ongoing of defense of claims.
• Performs medical records review, HFACS-RCA2 review and other evidence to support the defense of the organization.
• Initiates the claim file, secures documents, litigation holds and manages discovery requests, team member interviews, and deposition support.
• Coordinates efforts between the AdventHealth Corporate Services Risk Management Claims Manager and outside attorneys.
• Assists in the development of risk reduction strategies for the region including supporting the grievance resolution process to resolve them quickly and effectively.
• Provides leadership and facilitation to the annual initiatives to reduce claims costs for the hospitals and clinics.
• Provides local/Regional oversight of the Risk Management Information System (RMIS) establishing guidelines related to standardized scoring of incidents, access to the system and management of departments and reviewers for the region.
• Provides requested reports and analysis of data.
• Coordinates with AdventHealth Corporate Services Risk Management to ensure the appropriate procurement and maintenance of insurance coverage for the facilities, clinics and any leases within the region and the issuance of Certificates of Coverage as needed.
• Assists facilities and clinics in crisis intervention on serious risk incidents providing guidance on immediate, short term and long term interventions to reduce risk.
• Oversees the monthly claims review meetings, identifying incidents for discussion and identification of PCEs.
• Provides updates to the Quality teams on open claims and lawsuits for their entity.
• Provides support to the Director by providing back up to the Patient Safety Evaluation System, ensuring compliance with the PSQIA and protections of Patient Safety Work Product.
• Provides education on identified topics to team members and leadership across the region to improve awareness of identifies risks.
• Performs other duties as assigned.

Knowledge, Skills, and Abilities:

• Knowledge of insurance, workers’ compensation, HPL, GL claims management, and state/federal hospital-related reporting requirements. [Required]

Education:

• Bachelor's [Required]

Field of Study:

• Healthcare related field

Work Experience:

• 2+ years of Risk Management, Quality and Patient Safety experience [Required]

Additional Information:

• An equivalent combination of education and relevant work experience may be considered in lieu of the stated degree requirement:
• Bachelor's and 2+ years of Risk Management, Quality and Patient Safety experience [Required] OR
• Associate's and 4+ years of Risk Management, Quality and Patient Safety experience [Required] OR
• High School Grad and 6+ years of Risk Management, Quality and Patient Safety experience [Required]

Licenses and Certifications:

• Certified Professional in Healthcare Risk Management (CPHRM) [Preferred]

Physical Requirements:

Physical Requirements - (Please click the link below to view work requirements) Physical Requirements - https://tinyurl.com/23km2677

Pay Range:

$83,366.40 - $155,084.80

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.