Clinical Risk Management Analyst

• 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.

• If RN, Active, unrestricted registered nurse (RN) multi-state compact and/or single-state license with privileges to practice in the state(s) where the RN is providing client nursing services
• Graduate of a Board of Nursing approved nursing education program
• 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
• 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.

RN with at least 2 years of hospital practice experience preferred

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program