Clinical Risk Manager

Overview:

Now hiring a Clinical Risk Manager!

Presbyterian is seeking a Clinical Risk Manager to support activities to identify and reduce risk and possibility of 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 strategies. This position provides comprehensive healthcare risk management consultation to Presbyterian Healthcare Services (PHS).

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: Yes
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
• Remote: Open to remote applicants in the United States, except for the following states: Wyoming, North Dakota, and Ohio

Ideal Candidate:

Experience in nursing or other clinical field required. Five (5) to eight (8) years experience in the clinical/managerial arena with involvement in risk management activities required. 

• Experience in nursing or other clinical field required.
• Five (5) to eight (8) years experience in the clinical/managerial arena with involvement in risk management activities required. Proficiency in database and other computer programs desired
  
  

Education Essential: Bachelor Degree

Credentials Essential: Registered Nurse-NM

• Evaluates PHS risk management programs and efforts and promotes enhancement via customized recommendations for policy, procedure/practice and system modification.
• Assesses and provides consultative support through site visits, education and communication to improve problem/risk identification, resolution and evaluation processes by conducting assessments and reviews.
• Responds to routine and urgent requests from PHS, Administration or Legal for investigation and analysis
• Maintains current knowledge of regulatory and accreditation standards as they apply to PHS.
• Directs and obtains preliminary investigative information to determine initial liability exposure and provides guidance to limit exposures and improve loss control.
• Investigates risks involving actual or potential injury to patients visitors and employees; collects information necessary to prepare for the defense of claims. Collaborates in claims resolution process with attorneys and claims adjusters
• Investigates patient/family/consumer complaints and risk events that qualify as potentially compensable events. Supports development of action plans and oversees progress in completing them.
  Interacts with patients, members and families, legal counsel and insurance carriers to effect timely settlements.
• Active participation in patient safety goals and related committees
• Acts as a resource, internal consultant and educator for patient safety /risk management issues
• Answers medical/legal inquiries of physicians nurses and administrators regarding emergent patient care issues and loss control
• Acts as a resource for and responds to employee, management, or physician inquiries related to professional liability, standards of practice, policy and contract interpretation, applicable laws and regulations, system administration, release of information, risks associated with complaints, credentialing, provider issues, and other issues as they arise.
• Approves billing adjustments/write-offs; resolves and settles claims in pre-litigation status, within authority limits.
• Provides detailed medical records review and summaries for claim resolution and in anticipation of litigation.
• Reports patient care-related incidents to the Department of Health as required by law; directs investigation and development of corrective plans; submits required reports to state and federal agencies
• Responds to patient/member complaints and supports appropriate manager or administrator in responding as needed.
• Notification to carriers of actual or potential claims, determining appropriate financial reserves
• Provides periodic reports to Director, administration and Boards on sentinel events and action plans. *Plans, develops and presents educational material to all levels of the organization on topics related to risk management and loss mitigation
• Under supervision of Director, coordinates risk management processes with PHS Delivery system quality and safety initiatives and assures that risk management activities comply with applicable regulatory standards; serves as a resource to PHS committees and Performance Improvement teams as necessary
  
  

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 1600 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.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.