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Aurora Health Care · 2 weeks ago

Clinical Risk Management Analyst

Green Bay, WI

Full-time

Hybrid

Senior Level

$37/hr - $56/hr

5+ years exp

Aurora Health Care is a healthcare organization seeking a Clinical Risk Management Analyst. The role involves collaborating with claims adjustors and defense counsel to manage claims, analyzing patient concerns, and coordinating quality improvement initiatives while maintaining compliance with regulations.

Health Care

Responsibilities

Collaborates with claims adjustors and defense counsel in managing claims including assessment of liability, ensuring establishment of appropriate reserves, maintaining complete and up-to-date case files, and assisting in procurement of medical records and documents necessary for evaluation and defense of cases. Facilitates timely response and investigation of adverse and significant events

Collects and evaluates data concerning incident reports, aggregates data summaries, and develops monthly and quarterly risk management reports that provide a summary of current claims and litigation, to include an analysis of trends. Shares reports with appropriate leadership and advises and recommends actions for process improvement. Maintains an accurate, up-to-date database reflecting the status and essential elements of current claims and litigation

Analyzes patient concerns or complaints to determine the root of the matter, identifies any trends, and determines how best to address the concern or complaint. Reviews and gathers pertinent information from patient records. Collaborates with other risk staff in the prompt, equitable resolution of claims. Provides consultative and resource support to staff regarding all aspects of risk management

Coordinates, facilitates, implements and participates in care management and quality improvement initiatives. Collaborates with leadership and departments throughout Aurora and/or Aurora at Home (AatH) on process improvement plans to analyze, monitor and ensure high levels of quality and performance. Identifies opportunities for improvement and makes recommendations for change and implements them

Participates in medical record review against set guidelines and best practices to determine if care provided was within standards of care. Reviews, trends, and reports results of quality related state of federal visits, accreditation, and risk cases to leadership

Acts as a resource for other staff, leadership and physicians regarding quality management and risk management issues or topics

Collaborates in the development, delivery and evaluation of educational programs or tools that relate to safety, risk management and quality initiatives. May conduct quality and risk management educational programs for the agency

Assists with carrying out established processes for risk identification, risk investigation and risk reduction that may include risk surveys, inspection of patient care areas and chart auditing

Facilitates root cause analysis investigations, FMEA methodologies, reporting of adverse, significant and sentinel events

Complies with various codes, laws, rules, and regulations concerning patient care, including those mandated by state and federal agencies; assisting with the investigation activities of federal, state, and local enforcement authorities. Maintains current knowledge of state and federal regulatory and accreditation requirements including accrediting standards for home health, hospice, DME and IV Infusion: HCFA; OSHA; CDC, CLIA waivers

Qualification

Risk ManagementQuality ImprovementData AnalysisHealthcare RegulationsProcess ImprovementMedical TerminologyStatistical ToolsAnalytical SkillsConflict ManagementCommunication SkillsOrganizational SkillsTeam PlayerNegotiation Skills

Required

Facilitates timely response and investigation of adverse and significant events

Shares reports with appropriate leadership and advises and recommends actions for process improvement

Maintains an accurate, up-to-date database reflecting the status and essential elements of current claims and litigation

Analyzes patient concerns or complaints to determine the root of the matter, identifies any trends, and determines how best to address the concern or complaint

Reviews and gathers pertinent information from patient records

Collaborates with other risk staff in the prompt, equitable resolution of claims

Provides consultative and resource support to staff regarding all aspects of risk management

Coordinates, facilitates, implements and participates in care management and quality improvement initiatives

Collaborates with leadership and departments throughout Aurora and/or Aurora at Home (AatH) on process improvement plans to analyze, monitor and ensure high levels of quality and performance

Identifies opportunities for improvement and makes recommendations for change and implements them

Participates in medical record review against set guidelines and best practices to determine if care provided was within standards of care

Reviews, trends, and reports results of quality related state of federal visits, accreditation, and risk cases to leadership

Acts as a resource for other staff, leadership and physicians regarding quality management and risk management issues or topics

Collaborates in the development, delivery and evaluation of educational programs or tools that relate to safety, risk management and quality initiatives

May conduct quality and risk management educational programs for the agency

Assists with carrying out established processes for risk identification, risk investigation and risk reduction that may include risk surveys, inspection of patient care areas and chart auditing

Facilitates root cause analysis investigations, FMEA methodologies, reporting of adverse, significant and sentinel events

Maintains current knowledge of state and federal regulatory and accreditation requirements including accrediting standards for home health, hospice, DME and IV Infusion: HCFA; OSHA; CDC, CLIA waivers

Graduate of a Board of Nursing approved nursing education program

Bachelor's Degree in Risk Management or related field

Typically requires 5 years of experience in healthcare, quality and/or risk management, which includes experience in risk management principles, and continuous quality improvement tools and concepts

Knowledge of federal, state and other external health care regulations and standards and ability to research those regulations

Knowledge of evidence based, best practice resources to promote efficiency and effective outcomes

Working knowledge of process improvement methods and statistical tools

Effective conflict management and resolution skills

Basic working knowledge of medical terminology, clinical concepts and disease management

Intermediate computer skills including experience in using Microsoft Office (Excel, Word, Power Point, Access) or similar products

Strong written and oral communication skills including good presentation skills

Detail oriented with excellent organizational skills

Must be a team player with ability to interact with all levels of staff often in sensitive situations

Demonstrated analytical and problem solving skills to track outcomes

Must have the ability to influence change without direct authority and strong negotiation skills

Preferred

RN with at least 2 years of hospital practice experience preferred

Strong written and verbal communication skills (job requires interaction with medical, nursing, and ancillary department teammates as well as with patients and their families)

Clinical literacy; ability to manage workload and priorities efficiently

Ability to collaborate effectively with interdisciplinary teams