Quality Risk Management Analyst

11204 Enterprise Corporate - Risk Management

Full time

Yes

40

Fulltime, dayshift, Monday - Friday and this role will be mostly remote with ask to come onsite from time to time and must be local WI or norther IL.

No relocation and no sponsorship or transfer of visa for this position now or in the future.

Pay Range:

$38.20 - $57.30

Major Responsibilities:

• Collaborates with claims adjustors and defense counsel in managing claims including assessment of liability, ensuring establishment of appropriate reserves, maintaining complete and up-to-date case files, and assisting in procurement of medical records and documents necessary for evaluation and defense of cases. Facilitates timely response and investigation of adverse and significant events.
• Collects and evaluates data concerning incident reports, aggregates data summaries, and develops monthly and quarterly risk management reports that provide a summary of current claims and litigation, to include an analysis of trends. Shares reports with appropriate leadership and advises and recommends actions for process improvement. Maintains an accurate, up-to-date database reflecting the status and essential elements of current claims and litigation.
• Analyzes patient concerns or complaints to determine the root of the matter, identifies any trends, and determines how best to address the concern or complaint. Reviews and gathers pertinent information from patient records. Collaborates with other risk staff in the prompt, equitable resolution of claims. Provides consultative and resource support to staff regarding all aspects of risk management.
• Coordinates, facilitates, implements and participates in care management and quality improvement initiatives. Collaborates with leadership and departments throughout Aurora and/or Aurora at Home (AatH) on process improvement plans to analyze, monitor and ensure high levels of quality and performance. Identifies opportunities for improvement and makes recommendations for change and implements them.
• Participates in medical record review against set guidelines and best practices to determine if care provided was within standards of care. Reviews, trends, and reports results of quality related state of federal visits, accreditation, and risk cases to leadership.
• Acts as a resource for other staff, leadership and physicians regarding quality management and risk management issues or topics.
• Collaborates in the development, delivery and evaluation of educational programs or tools that relate to safety, risk management and quality initiatives. May conduct quality and risk management educational programs for the agency.
• Assists with carrying out established processes for risk identification, risk investigation and risk reduction that may include risk surveys, inspection of patient care areas and chart auditing.
• Facilitates root cause analysis investigations, FMEA methodologies, reporting of adverse, significant and sentinel events.
• Complies with various codes, laws, rules, and regulations concerning patient care, including those mandated by state and federal agencies; assisting with the investigation activities of federal, state, and local enforcement authorities. Maintains current knowledge of state and federal regulatory and accreditation requirements including accrediting standards for home health, hospice, DME and IV Infusion: HCFA; OSHA; CDC, CLIA waivers.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• Bachelor's Degree in Risk Management or related field.

Experience Required:

• Typically requires 5 years of experience in healthcare quality and/or risk management, which includes experience in risk management principles, and continuous quality improvement tools and concepts.

Knowledge, Skills & Abilities Required:

• Knowledge of federal, state and other external health care regulations and standards and ability to research those regulations.
• Knowledge of evidence based, best practice resources to promote efficiency 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 experience in using Microsoft Office (Excel, Word, Power Point, Access) or similar products.
• Strong written and oral communication skills including good presentation skills.
• Detail oriented with excellent organizational skills.
• Must be a team player with ability to interact with all levels of staff often in sensitive situations.
• Demonstrated analytical and problem solving skills to track outcomes.
• Must have the ability to influence change without direct authority and strong negotiation skills.

Physical Requirements and Working Conditions:

• Exposed to a normal office environment.
• Position requires travel; therefore may be exposed to road and weather hazards.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training

• Premium pay such as shift, on call, and more based on a teammate's job

• Incentive pay for select positions

• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs

• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability

• Flexible Spending Accounts for eligible health care and dependent care expenses

• Family benefits such as adoption assistance and paid parental leave

• Defined contribution retirement plans with employer match and other financial wellness programs

• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.