Clinical Risk Manager

Job Description Summary

We're looking for a Clinical Risk Manager who is passionate about patient safety, high reliability practices, and driving meaningful system wide improvement. The Clinical Risk Manager supports South Shore Health's system wide efforts to improve patient safety, reduce risk, and ensure regulatory compliance. This role conducts event investigations and root cause analyses, identifies trends, and partners with clinical and operational leaders to develop effective corrective actions. The position also assists with claims management, regulatory readiness, external reporting, and participates in a 24/7 on call rotation. In this role, you'll: Lead investigations and root cause analyses Identify trends and system risks through data and event review Partner with clinical + operational leaders to implement corrective actions Support regulatory readiness, accreditation, and required reporting Contribute to claims management and patient safety initiatives Help cultivate a culture of safety across the organization Who we're looking for: MA RN license Bachelor's degree (Master's preferred) 3+ years experience in hospital or health system risk management CPHRM, CPPS, or CPHQ (or willing to obtain within 1 year) A collaborative communicator with strong analytical and problem solving skills

Job Description

ESSENTIAL FUNCTIONS

Risk Management

• Participates in planning, implementing, managing, monitoring, and documenting an integrated, comprehensive and proactive risk management program for SSH.
• Collaborates with Patient Safety, Regulatory/Accreditation, Compliance, Quality Management, Office of Patient Experience and departmental quality and operations leaders to identify and assess unusual incidents, unexpected outcomes, and potential risks, translating learnings into the development of loss and error prevention strategies.
• Serves as internal consultant and facilitator for quality improvement committees and teams
• Recommends corrective and preventive actions to reduce risk. Collaborates with insurer and hospital-based improvement teams on interventions.
• Reviews and evaluates aggregate adverse events and claims data, as well as other hospital information in order to identify high-risk activities, procedures and departments.
• Performs root cause analysis on all serious reportable events (SREs) and other events as appropriate. Supports staff in investigation/review process, debriefs, corrective actions and follow-up. Completes required reporting and documentation in accordance with legal, regulatory, accreditation standards and requirements.
• As requested, serves as institutional liaison to professional/general liability insurers.
• Ensures appropriate and timely communications with health system and departmental leadership concerning professional/general liability matters.
• Under the direction of the Executive Director of Risk, Senior Clinical Risk Manager and the Office of General Counsel, assists in the claims management process for the hospital including directing management of legal claims involving hospital and staff and collaborates with insurers, as needed.
• Assists with supporting and coordinating Medical Staff Peer Review Committees, working closely with Medical Staff leadership, providing accurate clinical summaries, data trending, reports and analysis.
• Collaborates with the Patient Experience Department to assist in reviewing patient grievances. Works with team, as appropriate to respond to patient grievances.
• Partners with colleagues across the organization to coordinate and facilitate risk and safety education, complete collaborative risk reviews, and develop robust action plans.
• Integrates risk management program activities with clinical programs, hospital and health system operations and administration, such as patient safety, regulatory/accreditation compliance, patient care services, environmental safety, human resources, infection control, occupational health, clinical laboratories, physician services, information management, compliance/privacy, etc.
• Participates on the Quality Council, Joint Commission Core Team, Environment of Care Committee, and other committees, as need is identified.
• Development of institutional communication and education strategies related to Risk Management, quality and patient safety issues and compliance with emerging regulatory, case and statutory law.
• Participates in on-call schedule to enable 24/7 coverage for inquiries on risk management matters.

Patient Safety

• Performs comprehensive system analysis of patient safety events utilizing just culture principles and standard processes. Focuses on high reliability concepts when developing improvement initiatives.
• Reviews adverse event reports to ensure timely and appropriate analysis and follow up.
• Performs data analysis of safety event reporting relative to adverse incidents to identify trends, and signals of risk.
• Plays vital role in the management of risk /safety reportin