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CLINICAL RISK MANAGEMENT AND QUALITY ASSURANCE

Position Overview

• NO REMOTE

• The Risk Management is responsible for overseeing all organizational risk functions, including event reporting, patient safety, complaint resolution, regulatory compliance, and risk‑related education.

This role ensures the organization maintains a safe environment for patients and staff, complies with state and federal requirements, and proactively identifies and mitigates risk across all clinical operations. Essential Duties & Responsibilities Event Reporting & Risk Analysis

• Serve as the Administrator for RL Solutions and oversee the full event reporting lifecycle.
• Review, investigate, and trend incident data to identify patterns and areas of concern.
• Develop and deliver risk education based on trended data.
• Prepare quarterly risk reports for the CEO and Governing Board.
• Conduct the annual evaluation of the Risk Management Plan and establish new goals based on findings. Patient Complaints & Service Recovery
• Manage all "You Matter" phone calls and emails, ensuring timely follow‑up and resolution.
• Draft written responses to health plans regarding patient complaints.
• Maintain detailed logs of complaints, outcomes, and corrective actions.
• Round in offices when risk issues are identified to support staff and leadership. Regulatory Compliance & Documentation
• Conduct medical record reviews when Notices of Intent are received.
• Maintain updated risk files for active and potential cases.
• Collaborate with Billing and Coding to ensure timely completion of medical records.
• Work with Compliance and physicians on amended medical record requests.
• Participate in policy and procedure development related to risk and patient safety. Education & Training
• Administer annual company‑wide Risk Management training.
• Assist the Education Department with developing skills‑based competencies.
• Maintain updated competency forms based on changes to practice standards.
• Provide customer service and risk‑related training during new hire orientation. Emergency Preparedness
• Serve as a member of the Hernando ESF‑8 Emergency Management working group.
• Chair the EOC Committee during inclement weather or emergency events.
• Coordinate communication and readiness activities across clinical sites. Clinical & Operational Support
• Provide risk‑related guidance to physicians, COMs, and office staff.
• Respond to IPA Operations Managers when issues arise that involve risk or clinical concerns.
• Support offices with compliance audit corrective action plans.
• Collaborate with BluOne on risk software and educational video development. QualificationsEducation & Certifications
• RN and clinical experience in hospitals or SNFS in risk management roles, quality assurance and supervisory role is required Experience
• 3-5 years of experience in healthcare risk management, patient safety, or compliance.
• Experience with RL Solutions or similar event reporting systems.
• Strong understanding of clinical workflows and regulatory requirements. Skills
• Excellent communication, investigation, and documentation skills.
• Ability to analyze data, identify trends, and develop corrective action plans.
• Strong organizational and time‑management abilities.
• Proficiency in MS Office and EMR systems. Work Environment & Requirements
• Occasional travel to local offices for rounding and investigations.
• Must be able to sit, type, and use a computer for extended periods.
• Occasional lifting up to 10-25 lbs.

Pay:

$87,289.60 - $105,122.96 per year

Benefits:

401(k) Dental insurance Health insurance Life insurance Paid time off Vision insurance

Experience:

Medicare stars: 1 year (Preferred)

HEDIS:

3 years (Required) Patient assessment: 1 year (Preferred)

COMPLIANCE AUDIT

1 year (Preferred)

License/Certification:

RN License (Required) APRN (Preferred)

Work Location:

In person