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Clinical Risk Manager
3 weeks ago
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 you
Sinceri 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 Coordination
- Submit and manage claims to insurance carriers, ensuring accurate and timely processing
- Coordinate with insurance adjusters and carriers throughout the claims process
- Prepare comprehensive claim documentation and supporting materials
- Assist in annual insurance renewals by providing claims data and risk assessments
- Maintain detailed records of all claims activities and outcomes
- Analyze claims patterns to identify trends and prevention opportunities
- Work closely with attorneys on legal cases involving the organization
- Prepare clinical documentation and evidence for legal proceedings
- Attend trials and depositions as required to provide clinical expertise
- Monitor ongoing litigation and provide regular updates to management
- Assist in case strategy development from a clinical perspective
- Coordinate with expert witnesses and medical consultants
- Monitor litigation trends and loss runs to identify potential risk areas
- Conduct comprehensive risk assessments of communities and operations
- Analyze incident reports and claims data to identify patterns and root causes
- Develop and implement risk mitigation strategies and prevention programs
- Perform community risk assessments and safety inspections
- Work with communities on quality improvement processes and initiatives
- Provide clinical expertise to support quality assurance programs
- Investigate incidents and adverse events to determine contributing factors
- Collaborate with community teams to implement corrective action plans
- Monitor compliance with risk management policies and procedures
- Provide training and education to community staff on risk prevention
- Maintain accurate and detailed documentation of all risk management activities
- Prepare regular reports on claims status, litigation updates, and risk metrics
- Generate loss run reports and analysis for management review
- Document lessons learned and best practices from claims and litigation
- Ensure compliance with regulatory reporting requirements
- Maintain confidential and secure risk management records
- Participate in risk management committees and meetings
- Maintain relationships with insurance brokers and carriers
- Provide risk management consultation to executive leadership
- Participate in industry risk management organizations and training
- Perform other duties as assigned
- Bachelor's degree preferred in Nursing, Healthcare Administration, Risk Management, or related field preferred
- Current and unrestricted Registered Nurse (RN) of Licensed Practical Nurse (LPN)
- Minimum 5 years of clinical nursing experience, preferably in long-term care or assisted living
- 2+ years of experience in risk management, claims management, or healthcare administration
- Experience working with insurance carriers and claims processes
- Previous experience with legal proceedings or litigation support preferred
- Knowledge of healthcare regulations and compliance requirements
- Strong computer proficiency including Microsoft Office Suite
- Experience with claims management software and databases
- Ability to analyze data and generate comprehensive reports
- Knowledge of healthcare documentation standards
- Excellent clinical assessment and critical thinking skills
- Strong written and verbal communication abilities
- Ability to work effectively with attorneys and legal teams
- Professional demeanor for courtroom proceedings and depositions
- Detail-oriented with strong organizational skills
- Ability to handle sensitive and confidential information
- Problem-solving and analytical thinking capabilities
- Understanding of insurance processes and requirements
- Professional certification in risk management (ARM, CPHRM, or similar) preferred
- Experience with assisted living or senior care regulations
- Previous litigation support or expert witness experience
- Knowledge of state insurance regulations and requirements
- Experience with root cause analysis and quality improvement methodologies
