Risk Management Specialist

Adventist Health; St. Helena (CA); On-site; USD 70,000 - 90,000; Full time

Job summary

Adventist Health is looking for a Risk Management Associate to support risk management goals and collaborate with stakeholders including Claims, Legal, and Patient Safety teams. The role involves administration of new claims, grievances triage, and general support to the Risk Management Director.

The ideal candidate holds a Bachelor’s Degree in Nursing and has experience in nursing and risk management. A valid RN license is required. Adventist Health is faith-based, integrated health system serving diverse communities.

Qualifications

• Three years of nursing experience or general risk management is required.
• One year of leadership experience is preferred.
• Familiarity with professional liability insurance and claims handling is preferred.

Responsibilities

• Assists with managing actual and potential risks to the organization.
• Acts as a liaison to assess risk exposures in various situations.
• Ensures timely and accurate responses to inquiries for claims history.

Skills

Nursing experience

Leadership skills

Claims handling familiarity

Risk management

Education

Bachelor’s Degree in Nursing (BSN)

Job description

Job Description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus – a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well‑being and inspire your best work.

Job Summary

Performs key responsibilities that support the department in achieving risk management program goals for the organization. Key duties include initiation and review of new claims in the Event Reporting System; grievances, complaints and concerns triage, review, and resolution, and general administrative support to the Risk Management Director. Works collaboratively with stakeholders including but not limited to: Risk Management, Claims, Legal, Patient Safety, Quality, Accreditation, Regulatory, and Licensing teams. Serves as a risk management generalist to facilitate and perform the duties of the risk management department on a variety of hospital and clinic related topics including collaboration and communication with various stakeholders, patients, and medical staff.

Job Requirements

• Bachelor’s Degree in Nursing (BSN): Preferred
• Three years’ nursing experience or general risk management: Required
• One year leadership experience: Preferred
• Familiarity with professional liability insurance/claims handling: Preferred

Licenses/Certifications

• Registered Nurse (RN) licensure in the state of practice: Required

Essential Functions

• Assists with identifying and managing actual and potential risks to the organization. Reviews and manages event reporting system related to grievances, complaints, workplace violence, security, property, facilities, and claims, and other events as assigned. Participates in patient safety event review meetings and completes necessary follow‑up. Initiates review of events with high harm and potentially compensable events (PCEs).
• Acts as a liaison and resource to assess risk exposures in specific clinical and other situations (e.g. Facilities, Safety, Nursing, Pharmacy, Security, and Patient Relations). Works with Safety, Procurement, and Clinical Engineering and Clinical Operations to identify medical device and equipment failures for purposes of improving organizational risk, patient safety and for reporting to the Food and Drug Administration (FDA). Participates as member of various organizational councils/committees to provide risk management perspective and input for purposes of managing organizational risk and promoting safety activities.
• Ensures timely and accurate response to inquiries for claims history and coverage information. Monitors evidence preservation (e.g. surveillance video, equipment, etc, and/or litigation holds). Collaborates with Risk Management Director or Manager, Claims team, or internal or external legal counsels to coordinate review processes and procedures. Obtains, maintains records and documents and provides them to internal or external legal counsels for preparation of testimony in pending litigation. Safeguards documents obtained or developed for cause analysis to ensure documents/proceedings are protected from discovery. Participates in claims process which includes but is not limited to: coordination of depositions; response to interrogatories; requests for production of evidence; ensuring documentation and data management. Attends trial as site representative as directed by internal and external legal counsels. Safeguards documents obtained or developed for cause analysis to ensure documents/proceedings are protected from discovery.
• Supports Risk Management Director and various department leaders in analyzing data (e.g. complaints, grievances, claims, lawsuits) to identify priority topics and audiences for targeted training and education. Assists department staff to coordinate in‑services and education related to risk prevention, reduction, and mitigation strategies.
• Performs other job‑related duties as assigned.

Organizational Requirements

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E‑Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E‑Verify. By choosing to apply, you acknowledge that you have accessed and read the E‑Verify Participation and Right to Work notices and understand the contents therein.

About Us

Adventist Health is a faith‑based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God’s love by inspiring health, wholeness, and hope.