Risk and Insurance Specialist

1 month ago

Miami, United States CareMax Inc Full time
Job DescriptionJob Description

About Us:

HEART. It is the driving force of our commitment to serving others with empathy, respect, and dignity. CareMax, is committed to providing the best that medicine has to offer with quality healthcare for those who need it most, our seniors. Join our team and experience it for yourself. We are Health with Heart.

You can count on us to provide you with resources and opportunities for growth, while contributing to our mission to improve lives through kindness, compassion, and better health. This is what we offer:

  • Access to continual education through CareMax University
  • Starting with 18 days of Paid Time Off
  • 8 company paid holidays plus a floating holiday
  • 401(k) plan with company match
  • Comprehensive medical package

About You:

Are you ready to be a part of a team that values empathy, persistence, and excellence? As the Pharmacy Coordinator at CareMax, you'll be the linchpin in addressing pharmacy-related inquiries from our members and providers. Your primary focus will be on ensuring effective medication management, orchestrating improvements in the generic dispensing rate (GDR) by facilitating brand-to-generic conversions in alignment with health plan formularies. You'll serve as the Subject Matter Expert (SME) for medication-related inquiries within our medical center.

The Risk and Insurance Specialist is responsible for managing the CareMax, Inc. insurance portfolio, overseeing insurance claims, handling incident management, and ensuring patient safety. This role is crucial in mitigating risks and enhancing the overall safety and quality of patient care.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Insurance Portfolio Management:

  • Oversee the organization’s insurance portfolio, ensuring adequate coverage for all potential risks.
  • Manage the acquisition, renewal, and requirements of the company’s internal insurance program and handle day-to-day administration of insurance matters for various lines of coverage.
  • Review external contracts and advise on insurance provisions and requirements.
  • Manage the company’s certificates of insurance.
  • Serve as liaison between the company, insurance brokers, adjusters, and attorneys involved with any insurance claims.
  • Measure risk assessments against insurance costs and make financial/analytical recommendations in order to improve results.
  • Collaborate with team members, management, and other company personnel on projects involving risk and risk mitigation.
  • Gather and analyze required underwriting information.
  • Stay apprised of changes in exposures or operations in the insurance market.
  • Respond to audit requests in a timely manner.

Claims Management:

  • In partnership with the Legal team, manage all insurance-related claims, including documentation and communication with insurers.
  • Coordinate with relevant departments to gather necessary information and evidence for claims.
  • Monitor the progress of claims and ensure timely resolution and settlement.

Incident Management:

  • Develop and implement incident reporting and management systems.
  • Conduct thorough investigations of incidents, accidents, and near-misses to identify root causes and recommend corrective actions.
  • Maintain detailed records of incidents and track trends to develop proactive risk mitigation strategies.
  • Lead incident management and patient safety committee to review and address incidents and other patient safety risks.

Patient Safety:

  • Collaborate with clinical and administrative staff to promote a culture of safety and continuous improvement.
  • Lead patient safety initiatives, including risk assessments, safety audits, and the implementation of best practices.
  • Analyze patient safety data to identify patterns and develop strategies to reduce adverse events.

Compliance and Reporting:

  • Ensure compliance with all relevant regulations, standards, and guidelines related to risk management and patient safety.
  • Prepare and present regular reports on risk management activities, incidents, and patient safety outcomes to senior management.
  • Stay updated on industry trends, regulatory changes, and emerging risks in healthcare.

Training and Education:

  • Develop and deliver training programs for staff on risk management, incident reporting, and patient safety.
  • Provide guidance and support to staff on risk-related issues and foster a proactive approach to risk management.

Other Duties:

  • Assists the Chief Compliance Officer with internal investigations resulting from suspected noncompliance or potential fraud, waste, or abuse (FWA), as well as privacy incidents, whether discovered or reported, and implements corrective actions as needed.
  • Monitors follow up to address/resolve identified compliance, FWA, and privacy concerns. Ensures all reported or identified issues are appropriately documented with the associated corrective actions accurately and timely.
  • Ensures timely and appropriate follow up and closure of corrective action plans.
  • Identifies potential compliance risk areas and assists operational leadership with developing risk mitigation and/or corrective action plan strategies.
  • Establishes and fosters effective working relationships and builds credibility across business units.
  • Participates in professional organizations to stay abreast leading industry practices.
  • Performs other duties as assigned.

EXPERIENCE AND REQUIRED SKILLS

  • Bachelor’s degree in Healthcare Management, Risk Management, or a related field (Master’s degree preferred)
  • Minimum of 5 years of experience in healthcare risk management and insurance
  • Strong knowledge of insurance processes, claims management, quality, patient safety, and regulatory requirements
  • Certification in risk management (e.g., CPHRM) desirable
  • Excellent project management, analytical, problem-solving, and decision-making skills
  • Exceptional communication (written/oral), presentation, and interpersonal skills, and the ability to function effectively in a fast-paced environment.
  • Excellent time management skills with proven ability to effectively manage multiple tasks and priorities at one time
  • Proficiency in risk management software and incident reporting systems
  • Ability to adapt and respond to changes in environment and priorities
  • Ability to prioritize and plan work independently
  • Ability to anticipate potential issues and proactively respond
  • Ability to interact with all levels of an organization
  • Attention to detail a must

WORKING ENVIRONMENT AND PHYSICAL DEMANDS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

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