Clinical Risk Manager

Why You Should Work With Us:At Sinceri Senior Living, we are a fun loving, employee-centric company like no other Maybe that?s why we have been certified by our employees as a Great Place to Work ® for our 6th Year in a row. Create your career with us and learn about all the career growth opportunities we offer.Have we sparked your interest yet? Apply online and join our wonderful team. Questions about the application process? Come visit us and our staff will be happy to assist youSinceri Senior Living is proud to be an Equal Employment Opportunity employer. We celebrate diversity and do not discriminate based on race, religion, color, national origin, sex, sexual orientation, age, veteran status, disability status, or any other applicable characteristics protected by law. Minors must be at least 16 years of age to be employed by Sinceri Senior Living. Candidates submitted by unsolicited 3rd party recruiters will not be considered.Purpose:This critical role combines clinical nursing expertise with risk management responsibilities to protect our organization and residents through proactive risk assessment, claims management, and quality improvement initiatives. The position requires a Registered Nurse or Licensed Practical Nurse with strong analytical skills and the ability to work collaboratively with legal teams, insurance carriers, and community staff.Essential Job Functions:Claims Management & Insurance CoordinationSubmit and manage claims to insurance carriers, ensuring accurate and timely processingCoordinate with insurance adjusters and carriers throughout the claims processPrepare comprehensive claim documentation and supporting materialsAssist in annual insurance renewals by providing claims data and risk assessmentsMaintain detailed records of all claims activities and outcomesAnalyze claims patterns to identify trends and prevention opportunitiesLitigation Support & Legal CoordinationWork closely with attorneys on legal cases involving the organizationPrepare clinical documentation and evidence for legal proceedingsAttend trials and depositions as required to provide clinical expertiseMonitor ongoing litigation and provide regular updates to managementAssist in case strategy development from a clinical perspectiveCoordinate with expert witnesses and medical consultantsRisk Assessment & Loss PreventionMonitor litigation trends and loss runs to identify potential risk areasConduct comprehensive risk assessments of communities and operationsAnalyze incident reports and claims data to identify patterns and root causesDevelop and implement risk mitigation strategies and prevention programsPerform community risk assessments and safety inspectionsQuality Improvement & Community SupportWork with communities on quality improvement processes and initiativesProvide clinical expertise to support quality assurance programsInvestigate incidents and adverse events to determine contributing factorsCollaborate with community teams to implement corrective action plansMonitor compliance with risk management policies and proceduresProvide training and education to community staff on risk preventionDocumentation & ReportingMaintain accurate and detailed documentation of all risk management activitiesPrepare regular reports on claims status, litigation updates, and risk metricsGenerate loss run reports and analysis for management reviewDocument lessons learned and best practices from claims and litigationEnsure compliance with regulatory reporting requirementsMaintain confidential and secure risk management recordsAdditional ResponsibilitiesParticipate in risk management committees and meetingsMaintain relationships with insurance brokers and carriersProvide risk management consultation to executive leadershipParticipate in industry risk management organizations and trainingPerform other duties as assignedMinimum Eligibility RequirementsBachelor\'s degree preferred in Nursing, Healthcare Administration, Risk Management, or related fieldCurrent and unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN) Minimum 5 years of clinical nursing experience, preferably in long-term care or assisted living2+ years of experience in risk management, claims management, or healthcare administrationExperience working with insurance carriers and claims processesPrevious experience with legal proceedings or litigation support preferredKnowledge of healthcare regulations and compliance requirementsStrong computer proficiency including Microsoft Office SuiteExperience with claims management software and databasesAbility to analyze data and generate comprehensive reportsKnowledge of healthcare documentation standardsExcellent clinical assessment and critical thinking skillsStrong written and verbal communication abilitiesAbility to work effectively with attorneys and legal teamsProfessional demeanor for courtroom proceedings and depositionsDetail-oriented with strong organizational skillsAbility to handle sensitive and confidential informationProblem-solving and analytical thinking capabilitiesUnderstanding of insurance processes and requirementsPreferred QualificationsProfessional certification in risk management (ARM, CPHRM, or similar) preferredExperience with assisted living or senior care regulationsPrevious litigation support or expert witness experienceKnowledge of state insurance regulations and requirementsExperience with root cause analysis and quality improvement methodologies #J-18808-Ljbffr