Clinical Risk Manager Sr

Job Summary

The Senior Clinical Risk Manager leads the investigation and management of complex, high-severity risk events across the healthcare system. They provide strategic leadership and oversight in the identification, evaluation, and mitigation of clinical risks for their assigned areas. This role provides expert-level consultation on clinical risk, supports regulatory compliance, and leads enterprise-wide initiatives to enhance patient safety and reduce liability.

Essential Functions

• Leads the identification and investigation of high-severity risk events, including coordination with legal, patient safety, compliance, and executive leadership.

• Collaborates with legal counsel on complex claims and litigation support.

• Oversees and guides Root Cause Analyses (RCAs), Failure Mode and Effects Analyses (FMEAs), Apparent Cause Analysis, and other risk assessments.

• Leads proactive risk assessments for high-risk areas.

• Serves as a senior advisor to clinical and operational leaders on risk mitigation strategies and patient safety initiatives.

• Develops and communicates with senior management on appropriate responses to risk events and medical care complaints in accordance with legal requirements.

• Develops and implements system-wide risk management standard work, protocols, and policies.

• Leads the development and delivery of advanced risk management education and training.

• Provides mentorship, training, and support for clinical risk managers.

• Analyzes system-wide trends in incident reporting, tracks key performance indicators, and develops strategic recommendations for improvement.

• Regularly provides leadership with progress reports and data (including recommendations) related to risk management.

• Provides leadership of performance improvement and loss prevention activities.

• Represents the Risk Management department on committees and task forces focusing on high-risk issues.

• Investigates alleged EMTALA violations.

• Ensures that applicable regulatory and accreditation requirements are met in a proactive manner.

• Participates in development of processes/systems designed to share and recognize performance improvements and compliance across the organization to mitigate risks to patient and caregiver safety/risks to the organization.

• Facilitates teams related to system-wide approaches for risk mitigation.

• Serves as system subject matter expert for risk mitigation strategies on high-risk topics such as OB, ED, ICU and Behavioral Health service lines or Informed Consent, Use of Force oversight, Laser Safety, Medical Device Reporting, Adoptions and other topics.

• Assists Patient Relations to address complex grievances that involve patient care and responds to the patient in the time frame designated by policy.

• Partners with the Quality department, leads the organization’s regulatory response in the event of a formal patient complaint or EMTALA survey and corrective action plan.

• Serves as the lead for the communication & resolution program (disclosure process) in assigned areas of responsibility.

• Monitors and interprets changes in healthcare regulations and proactively adjusts risk strategies to maintain compliance.

• Serves as the non-discrimination officer for their assigned areas of responsibility.

• Performs other duties as assigned.

Qualifications

• Education: Bachelor's Degree Required: in Nursing or other clinical field; Master's Degree Preferred: in nursing, healthcare administration, public health or related field.

• Experience: Minimum of 5 years Required: Healthcare risk management, compliance, quality improvement or patient safety; Minimum of 5 years Required: Combination of directly related clinical experience AND risk management, compliance, quality improvement, or patient safety.

• Credentials: Required: RN, or license clinical discipline (RN preferred) in OR, WA, or AK; Required: within 2 years Certified Professional Healthcare Risk Management.

• Skills: Advanced knowledge of state, federal, and accreditation requirements including but not limited to: CMS Conditions of Participation for acute care and critical access hospitals. (Required); General knowledge in other regulatory areas such as, OSHA, EMTALA, and HIPPA. (Required); State healthcare rules and statutes, and state licensing requirements. (Required); Proficient with MS Office applications. (Required); Excellent communication, interpersonal, collaboration, and presentation skills. (Required); Advanced analytical and problem-solving skills. (Required); Ability to lead and motivate teams, influence others, and drive change. (Required); Able to work flexible hours. (Required); Participation in on-call coverage. (Required).