Job Description

Overview

Job Summary:

The Risk Management Manager is responsible for designing, organizing, coordinating, and implementing an integrated, organization-wide Risk Management Program. The primary objective of this role is to control and minimize financial, physical, and human loss, thereby protecting the human, physical, and fiscal assets of the healthcare facility.

The manager actively participates in performance improvement data collection, activities, and functions to promote an integrated healthcare delivery system that ensures the provision of high-quality care. Additionally, this role collaborates closely with safety, security, and administrative personnel to maintain regulatory compliance and proactive risk mitigation.

Responsibilities

Risk Mitigation & Occurrence Reporting

• Design, implement, and maintain an integrated, organization-wide occurrence reporting system to identify adverse events and potential system vulnerabilities.
• Conduct Root Cause Analyses (RCA), Failure Mode and Effects Analyses (FMEA), and comprehensive investigations for clinical and non-clinical incidents affecting patient safety.
• Review and update the facility Risk Management Plan at least annually.
• Provide feedback and progress reports to Administration, the Governing Board, and relevant medical staff committees.

Claims & Legal Management

• Direct and coordinate the organization's claims management process, serving as the liaison to insurance personnel, adjusters, and legal counsel.
• Determine potential liability and probability of legal action, ensuring timely notification to executive leadership, insurance carriers, and government agencies.
• Manage legal summons, notices of intent, and internal claims files, assisting staff members (defendants) throughout all phases of the claims process.
• Facilitate prompt resolution or payment for property loss or damages following appropriate administrative approval.

Quality Improvement, Contracts & Compliance

• Review and evaluate new and existing contracts, renewals, monitoring metrics, and annual contract evaluations.
• Oversee the Medical Provider Professional Liability Schedule as well as auto, driver, and property insurance coverage in collaboration with relevant departments.
• Analyze facility policies, procedures, bylaws, and forms for adherence to current state/federal laws and regulatory standards.
• Coordinate and deliver in-service educational programs on healthcare risk management during new employee orientation and ongoing staff training.

Qualifications

Education & Certifications

• Education: Bachelor of Science in Nursing (BSN) or related healthcare field preferred.
• Certifications: Fellow/Diplomate of the American Society for Health Care Risk Management (ASHRM) or Associate in Risk Management (ARM) designation preferred.

Professional Experience

• Minimum of 5 years of clinical and/or management experience in a multidisciplinary healthcare setting.
• Minimum of 2 years of inpatient operational experience required.
• Professional experience in risk management and/or professional liability claims management preferred.
• Thorough knowledge of applicable state and federal healthcare laws, regulations, and hospital safety protocols.