Clinical Risk Management Manager

We are seeking a Clinical Risk Management Consultant to join our Cornell Insurance Services team in Edison, NJ. This role focuses on identifying, assessing, and mitigating clinical risks for healthcare providers within an insurance brokerage firm, leveraging medical expertise to analyze potential claims, advise clients on risk reduction, and collaborate with underwriters on coverage decisions.

Responsibilities

• Clinical Risk Assessment: Review medical records, incident reports, and claims data to identify potential clinical risks, including medication errors, standard of care compliance risks, and diagnostic errors. Detect and manage risk exposure, maintain and update organizational policies, improve documentation practices, and reduce legal exposure. Create and maintain risk audit databases and advise clients on preventing data breaches. Investigate events resulting in death or injuries.
• Trend Analysis: Analyze clinical data to identify trends and patterns of risk within a healthcare provider's practice to enable proactive risk mitigation strategies.
• Risk Mitigation Consulting: Advise clients on clinical best practices, quality improvement initiatives, and risk reduction strategies to minimize potential claims.
• Claims Review and Analysis: Evaluate clinical aspects of claims, including medical necessity and appropriateness of treatment, to identify areas for improvement and potential cost savings.
• Underwriting Support: Collaborate with underwriters to assess clinical risk profiles of healthcare providers, informing coverage recommendations and premium calculations.
• Education and Training: Develop and deliver clinical risk management training programs for healthcare providers, covering topics such as informed consent, documentation best practices, and patient safety.
• Regulatory Compliance: Stay updated on relevant healthcare regulations and industry standards to ensure clients adhere to appropriate clinical risk management practices.

Requirements

• Clinical Background: Active license as a Registered Nurse (RN), Physician Assistant (PA), or other relevant healthcare professional with significant clinical experience.
• Risk Management Knowledge: Understanding of risk management principles, including risk identification, assessment, mitigation, and transfer.
• Analytical Skills: Ability to analyze complex medical data and identify potential risk factors.
• Communication Skills: Effective communication skills to interact with healthcare providers, underwriters, and clients, explaining complex clinical issues clearly and concisely.
• Problem-Solving Skills: Ability to identify root causes of clinical incidents and develop practical solutions to mitigate risk.

Qualifications

• Bachelor’s degree in Nursing or other health-related science; Master's degree preferred.
• 3-5 years of Risk Management experience preferred.
• Skilled Nursing Facility experience in the geriatric field preferred.
• RN, NP, PA, or allied health professional licensure required.
• Certified Professional in Healthcare Risk Management (CPHRM) preferred.

Pay

Pay Transparency Range: $100,000 USD - $125,000 USD. Actual salaries will vary based on factors including performance, location, and experience. This range is one component of the total compensation package.

Benefits

• Comprehensive health-related benefits, including medical, vision, and dental.
• 401(k) with company match.
• Company-paid life insurance, short-term disability (STD), and long-term disability (LTD).
• Generous PTO policy starting at 18 days per year, plus 10 paid holidays and 2 floating holidays.