Risk Manager

Albany Medical Center; City of Albany (NY); On-site; USD 95,000 - 147,000; Full time

Job summary

Albany Medical Center is seeking a Risk Manager to lead sentinel event reviews, loss control, and quality assurance initiatives within the Risk Management department. The role focuses on sentinel event/RCA processes, data reporting, and regulatory compliance across service areas.

Responsibilities include managing reporting systems, facilitating improvement teams, developing action plans, and coordinating with DOH/OMH/DNV.

Qualifications

• Associate degree in health care- or business-related field required.
• Bachelor’s degree in nursing preferred.
• Two years of auditing, compliance and/or coding experience required.
• Epic experience preferred.

Responsibilities

• Manage the Occurrence Reporting System and sentinel event process.
• Facilitate assigned improvement teams in analyzing events, identifying performance problems in work processes, redesigning work processes, and implementing possible improvements
• Prepare debriefs and or root cause analysis reports, which meet regulations, as well as serve the needs of the work teams problem solving.
• Design, develop, and implement a process for monitoring of action plans.
• Manage the selection, preparation, and dissemination of occurrence/quality data and reports that apply sound statistical process control and quality assurance concepts.
• Manage events and safety occurrences within service area
• Follow sentinel event protocol
• Complete RCA process within DOH guidelines and following the departmental protocol.

Skills

Auditing

Compliance

Coding (CPT)

MS Office

Epic

Communication skills

Clinical knowledge

Detail oriented

Team player

Analytics

Education

Associate degree in health care-related or business-related field

Bachelor’s degree in nursing preferred

Tools

Epic

MS Office

Job description

Department/Unit:

Risk Management

Work Shift:

Day (United States of America)

Salary Range:

$94,957.00 - $147,183.00

The Risk Manager will represent Albany Medical Center through involvement in quality/risk oriented professional organizations, delivering presentations, publishing, and maintaining contacts with members of the business community and professional organizations. Play an integral role in special projects within the department and Center-wide.

Essential Functions

Sentinel Event/RCA & Occurrence Review/Reporting

• Manage the Occurrence Reporting System and sentinel event process.
• Facilitate assigned improvement teams in analyzing events, identifying performance problems in work processes, redesigning work processes, and implementing possible improvements
• Prepare debriefs and or root cause analysis reports, which meet regulations, as well as serve the needs of the work teams problem solving.
• Design, develop, and implement a process for monitoring of action plans.
• Manage the selection, preparation, and dissemination of occurrence/quality data and reports that apply sound statistical process control and quality assurance concepts.
• Manage events and safety occurrences within service area
• Follow sentinel event protocol
• Complete RCA process within DOH guidelines and following the departmental protocol.
• Report to DOH immediately upon completion of Root Cause Analysis
• Manage the Sentinel Event alert process.
• Oversee Culture of Safety workgroups
• Complete FMEA and comply with regulatory requirements.

Loss Control

• Manage the reportable event process
• Identify any and all reportable events within service area
• Report in timely manner
• Respond to any inquiry’s from the regulatory bodies within service area
• Design, develop and manage early warning system for service area
• Manage loss control strategy development for service area.
• Manage, design and develop RM educational efforts for service area.
• Manage, design and develop system review process for service areas.
• Assist with and manage the data analysis process within service area.
• Liaison with DOH, OMH, DNV and other agencies as necessary.
• Provide support and advice to members of the service area involved in sentinel events or claims/litigation.

Minimum Qualifications:

Education:

• Associate degree in health care-related or business-related field required
• Bachelor’s degree in nursing preferred

Licensure, Certification & Registration:

• RHIT, RHIA, CCS, or CPC required
• Registered Nurse (RN) preferred

Experience:

• Two years of experience in auditing, compliance and/or coding required. High school diploma and 4+ years of relevant experience accepted in lieu of an Associate’s degree.
• Minimum of three years’ experience in a clinical setting preferred
• Epic experience preferred

Skills, Knowledge & Abilities:

• Knowledge of third-party billing regulations for hospital and/or provider reimbursement
• Experience and understanding of the CPT coding system
• Knowledge of medical necessity edits related to local and national coverage determinations(LCDs and NCDs), correct clinical initiatives (CCIs) and medically unlikely edits (MUEs)
• Strong clinical knowledge and clinical documentation practices
• Excellent verbal and written communication skills
• Experience with navigating within the electronic medical record, experience with Epic preferred
• Strong critical thinking skills
• Detail orientated and ability to prioritize multiple tasks/projects when varying deadlines
• Engaged and collaborative team player, contributing to the overall success of team
• Experience utilizing MS office products

Thank you for your interest in Albany Med Health System!

Albany Med Health System is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.