DIRECTOR OF CLINICAL RISK MANAGEMENT AND QUALITY ASSURANCE

DIRECTOR OF CLINICAL RISK MANAGEMENT AND QUALITY ASSURANCE

Position Overview

• NO REMOTE

• The Director of 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 (Required)

COMPLIANCE AUDIT

1 year (Required)

License/Certification:

RN License (Required) APRN (Preferred)

Work Location:

In person