Clinical Risk Manager

Martin’s Point Health Care•Portland, ME

22h

About The Position

The Clinical Risk Manager drives optimization of patient safety, reduction of risk of harm, and ensures regulatory adherence for all health center departments and sites. Performs detailed analyses of individual incidents and trends, creates tactics and tools to mitigate recurrent adverse events and partners with Delivery System (DS) leadership to implement change to improve patient care outcomes and experience. Serves as a subject matter expert on all relevant clinical state policy and ensures DS Clinical Policies and Procedures are up-to-date and compliant with regulatory guidance. This position also oversees staff in the data collection and reporting activities for external quality programs deemed of interest by senior leadership.

Requirements

Bachelor’s degree in nursing required
Current, unrestricted Registered Nurse licensure in Maine
American Society for Healthcare Risk Management (ASHRM) Certified Professional in Healthcare Risk Management (CPHRM) required upon hire or completed within first year
5+ years of nursing experience required
Experience in risk mitigation and quality assurance, quality and safety improvement, and regulatory readiness activities
Competence with computers and business applications: Microsoft Outlook, Excel, Word, and Power Point
Superb critical thinking and analytical skills and ability to identify root causes of problems
Strong interpersonal skills and able to build strategic relationships across organization
Ability to gather, interpret and present data to teams, senior leadership, and external partners
Systems thinker who can contribute to strategic and tactical planning, developing, and supporting implementation of creative solutions
Possess ability to interpret and simplify communications of regulatory standards, and remain up to date on changes to requirements
Proactive approach and able to work independently, highly organized
Excellent written and oral communication skills, able to discuss negative events with others in a supportive and non-punitive manner
Ability to build collaborative relationships with multi-disciplinary teams supporting the achievement of objectives, without direct authority
Inspire others toward the goal of continuous quality and safety improvement
Manage multiple competing demands, able to prioritize and make sound decisions

Nice To Haves

Master’s degree in nursing, Business, or Health Care Management preferred

Responsibilities

Develops and drives policy, protocols and procedures required to support quality assurance and regulatory compliance as determined by state law or leadership at Martin’s Point
Ensures adherence to all applicable State laws by remaining up to date on relevant and new standards or requirements
Disseminates knowledge of policy and procedure, working with practice leaders to support staff education on quality assurance and regulatory related issues
Owns the development and improvement of Martins Point’s internal event reporting system in partnership with IT
Fosters a “culture of safety” to ensure staff feel safe reporting adverse and near-miss events
Conducts Root Cause Analysis for clinical adverse event trends and high-risk events; develops action plans to reduce risk of recurrence; follows the progress of these action plans to completion with all assigned parties
Provides quarterly and annual reports of trended incidents with recommendations to DS Senior Leadership, and on request to the Executive Management Team
Recommends and develops selected case reviews, in consultation with the VP of Clinical Integration, and leads Peer Review of the highest risk clinical adverse events with the goal to improve quality and safety of care as well as internal processes; follows the progress of these action plans to completion with all assigned parties
Manages, in partnership with Practice Leadership and Practice Quality Steering, high priority clinical quality and safety improvement projects, and develops supporting policy, communication, and job aids
Provides support and guidance to Compliance and Legal Affairs for all clinically related matters
Creates and delivers New Provider Onboarding activities related to clinical risk, patient safety education, and best practices
Provides ad hoc consultation to front line providers and Practice Medical Directors on request
Remains abreast of CMS Medicare and Medicaid quality performance programs; raising attention re. program changes, new opportunities, and performance barriers
Manages NCQA PCMH Recognition certification process across the Delivery System, to include a broad understanding of the theoretical framework, standards, and guidelines, eligibility, application, and documentation processes
Manages MIPS MACRA submission and compliance efforts across the Delivery System in coordination with the Clinical Informatics Team
Performs other duties as requested by leadership team