Quality Risk Management Analyst

Advocate Health•Milwaukee, WI

20h•$38 - $57•Hybrid

About The Position

The Quality Risk Management Analyst supports claims and litigation management, risk identification and reduction, patient concern resolution, and quality improvement across Advocate Aurora and/or Aurora at Home. The role works with claims adjusters, defense counsel, risk staff, leadership, departments, staff, and physicians to investigate events, assess care and liability, analyze trends, recommend improvements, and support timely, equitable outcomes. It also helps ensure compliance with relevant patient-care, regulatory, and accreditation requirements, including standards applicable to home health, hospice, DME, and IV infusion. This is a full-time, 40-hour-per-week, day-shift position scheduled Monday through Friday. It is mostly remote, with occasional onsite work, and candidates must be local to Wisconsin or northern Illinois. The position requires travel and may involve exposure to road and weather hazards. No relocation or visa sponsorship or transfer is available.

Requirements

Bachelor's degree in Risk Management or a related field.
Typically five years of experience in healthcare quality and/or risk management, including risk management principles and continuous quality improvement tools and concepts.
Knowledge of federal, state, and other external healthcare regulations and standards, and ability to research them.
Knowledge of evidence-based and best-practice resources to promote efficient and effective outcomes.
Working knowledge of process improvement methods and statistical tools.
Effective conflict management and resolution skills.
Basic working knowledge of medical terminology, clinical concepts, and disease management.
Intermediate computer skills, including Microsoft Office (Excel, Word, PowerPoint, and Access) or similar products.
Strong written and oral communication and presentation skills.
Detail orientation and excellent organizational skills.
Ability to work as a team player and interact with all levels of staff, including in sensitive situations.
Demonstrated analytical and problem-solving skills to track outcomes.
Ability to influence change without direct authority and strong negotiation skills.
Ability to travel as required.
No licensure, registration, or certification required.

Responsibilities

Collaborate with claims adjusters and defense counsel to manage claims, assess liability, establish appropriate reserves, maintain current case files, and obtain records and documents needed to evaluate and defend cases.
Facilitate timely responses to and investigations of adverse and significant events.
Collect and evaluate incident-report data; prepare monthly and quarterly risk management reports summarizing claims and litigation and analyzing trends; share findings with leadership and recommend process improvements.
Maintain an accurate database of current claims and litigation and their essential details and status.
Analyze patient concerns and complaints, identify root causes and trends, review relevant patient records, and collaborate with risk staff to support prompt, equitable resolutions.
Provide consultative and resource support to staff on risk management matters.
Coordinate, facilitate, implement, and participate in care management and quality improvement initiatives with leadership and departments throughout Aurora and/or Aurora at Home.
Identify improvement opportunities, recommend changes, and implement process improvement plans; analyze and monitor performance and quality outcomes.
Review medical records against guidelines and best practices to assess whether care met standards; review, trend, and report results of quality-related state or federal visits, accreditation, and risk cases to leadership.
Serve as a resource to staff, leadership, and physicians on quality and risk management topics.
Collaborate in developing, delivering, and evaluating educational programs or tools related to safety, risk management, and quality initiatives; may conduct education programs for the agency.
Carry out established risk identification, investigation, and reduction processes, which may include risk surveys, patient-care-area inspections, and chart audits.
Facilitate root cause analysis investigations, FMEA methodologies, and reporting of adverse, significant, and sentinel events.
Comply with patient-care codes, laws, rules, and regulations, including requirements from state and federal agencies; assist with investigations by federal, state, and local enforcement authorities.
Maintain current knowledge of applicable state and federal regulatory and accreditation requirements, including HCFA, OSHA, CDC, and CLIA waiver requirements.