Clinical Risk Manager

Sinceri Senior Living•Dallas, TX

43d

About The Position

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.

Requirements

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

Nice To Haves

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

Responsibilities

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