Clinical Risk Management Manager

Foundation Risk Partners, one of the fastest growing insurance brokerage and consulting firms in the US, is adding a Clinical Risk Management Consultant to their Cornell Insurance Services team in the Edison, NJ office.

Job Summary:

The Clinical Risk Management Consultant is focused on identifying, assessing, and mitigating clinical risks for healthcare providers within an insurance brokerage firm, utilizing their medical expertise to analyze potential claims, advise clients on risk reduction strategies, and work with underwriters to secure appropriate coverage based on clinical risk factors.

Essential Functions:

• Clinical Risk Assessment:
  • Review medical records, incident reports, and claims data to identify potential clinical risks associated with patient care, including medication errors, standard of care compliance risks, and diagnostic errors.
  • Detect and manage risk exposure
  • Maintain and update an organization's policies
  • Improve documentation practices
  • Seek ways to reduce the legal exposure of the organization
  • Create and maintain risk audit databases
  • Identify for clients’ ways to take the steps needed to prevent data breaches
  • Investigate any events that result in death or injuries
• Trend Analysis:
  • Analyze clinical data to identify trends and patterns of risk within a healthcare provider's practice, allowing for proactive risk mitigation strategies.
• Risk Mitigation Consulting:
  • Advise clients on clinical best practices, quality improvement initiatives, and risk reduction strategies to minimize potential claims.
• Claims Review and Analysis:
  • Evaluate clinical aspects of claims, including medical necessity and appropriateness of treatment, to identify areas for improvement and potential cost savings.
• Underwriting Support:
  • Collaborate with underwriters to assess clinical risk profiles of healthcare providers, informing coverage recommendations and premium calculations.
• Education and Training:
  • Develop and deliver clinical risk management training programs for healthcare providers, including staff on topics like informed consent, documentation best practices, and patient safety.
• Regulatory Compliance:
  • Stay updated on relevant healthcare regulations and industry standards to ensure clients are adhering to appropriate clinical risk management practices.

Competencies & Qualifications:

• Clinical Background:
  • Registered Nurse (RN), Physician Assistant (PA), or other relevant healthcare professional license with significant clinical experience.
• Risk Management Knowledge:
  • Understanding of risk management principles, including risk identification, assessment, mitigation, and transfer.
• Analytical Skills:
  • Ability to analyze complex medical data and identify potential risk factors.
• Communication Skills:
  • Effective communication skills to interact with healthcare providers, underwriters, and clients, explaining complex clinical issues in a clear and concise manner.
• Problem-Solving Skills:
  • Ability to identify root causes of clinical incidents and develop practical solutions to mitigate risk.

Note: The specific responsibilities of an insurance broker clinical risk management role may vary depending on the size and focus of the brokerage firm, as well as the healthcare provider clientele they serve.

Education & Experience:

• Bachelor’s degree in Nursing, or other health related science
• Master's preferred
• 3-5 years Risk Management experience preferred
• Skilled Nursing Facility experience preferred in the geriatric field
• RN, NP or P.A. or allied health professional licensure
• CPHRM preferred