Job Description
Clinical Risk Manager
York, PA (Hybrid)
$80/HR
The Clinical Risk Manager will serve in medical malpractice and claims management to provide comprehensive risk management services to healthcare entities by evaluating potential financial and liability exposures and ensuring appropriate insurance coverage and claims handling processes are in place. This role oversees the management of medical malpractice and commercial insurance claims, coordinates litigation activities, and ensures claims are handled promptly, effectively, and in accordance with established policies.
The position manages the day-to-day operations of the claims function, provides oversight for litigation and claims activity, and supports leadership through reporting, analysis, and strategic guidance related to risk exposure and litigation trends.
Clinical Risk Manager Responsibilities
Oversee the full lifecycle of medical malpractice and related claims, including investigation, documentation, and resolution.
Track, review, and analyze newly litigated cases to assess complexity, potential exposure, and opportunities for resolution.
Assist in developing litigation strategies by reviewing case assessments and collaborating with defense counsel.
Attend trials when necessary and provide ongoing oversight of litigation activity.
Identify, collect, and preserve materials requested during discovery to support investigations and legal proceedings.
Manage relationships with outside counsel, including assigning cases, monitoring litigation progress, and overseeing settlement negotiations.
Review and approve outside counsel invoices to ensure accuracy and appropriate billing practices.
Investigate allegations of inappropriate treatment or care resulting in patient or visitor injury and determine appropriate next steps.
Respond to inquiries related to risk management and claims issues.
Participate in risk assessments and root cause analyses as requested.
Review incident and event reports and assist with investigations and regulatory reporting decisions.
Provide educational sessions on risk management topics to internal stakeholders as needed.
Develop reporting metrics and prepare periodic reports related to claims activity, litigation trends, and risk exposure.
Communicate key updates to leadership, including litigation developments, trial updates, and reserve adjustments.
Prepare summaries and analysis to support leadership decision-making regarding claims management and risk mitigation.
Coordinate with internal and external stakeholders including attorneys, consultants, and governing bodies regarding claims and litigation matters.
Provide direction and oversight of daily claims management operations.
Maintain accurate records, documentation, and reporting related to claims and litigation.
Ensure compliance with established policies, procedures, and risk management standards.
Support departmental operations and assume responsibilities of the Risk Manager when necessary.
Clinical Risk Manager Qualifications
Bachelor's Degree Required, Master’s degree preferred.
Minimum of 5 years of experience in healthcare, insurance, or risk management environments.
Demonstrated experience managing medical malpractice claims and litigation.
Experience with commercial insurance claims strongly preferred.
Background in claims management or paralegal work preferred.
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