Clinical Risk Manager
.png){kind=logo}
TrueCare is a trusted healthcare provider serving San Diego and Riverside Counties, offering compassionate and comprehensive care to underserved communities. We are committed to making healthcare accessible to everyone, regardless of income or insurance status. With a focus on culturally sensitive, affordable services, TrueCare aims to improve the health of diverse communities. Our vision is to be the premier healthcare provider in the region, delivering exceptional patient experiences through innovative, integrated care.
The Clinical Risk Manager is responsible for ensuring the safety and quality of patient care within the outpatient facility. This role involves identifying, evaluating, and mitigating clinical risks, developing and implementing risk management strategies, and ensuring compliance with regulatory requirements. In addition to risk management duties, this position also has oversight responsibilities related to health plan audits, ensuring accurate documentation and facilitating the smooth operation of audits within the facility.
Duties & Responsibilities:
Clinical Risk Management:
- Develop, implement, and manage clinical risk management programs to reduce patient harm, enhance patient safety, and maintain high standards of care.
- Identify and assess potential risks related to clinical practices, equipment, and processes.
- Collaborate with clinical staff to monitor patient safety concerns, such as adverse events, near misses, and safety incidents.
- Lead root cause analysis (RCA) for clinical incidents and work with the clinical team to design corrective actions.
- Conduct regular audits and inspections to assess compliance with facility policies, clinical protocols, and regulatory standards.
- Provide training and education to staff on risk management policies, patient safety, and best practices.
- Oversee and manages occurrence reporting system including timely responses and regular reporting.
- Oversee and manage evaluation and response to patient grievances.
Regulatory Audit Oversight:
- Serve as the main point of contact for regulatory audits, ensuring timely preparation and response to audit requests.
- Oversee the coordination and submission of accurate and complete clinical documentation required for audits.
- Oversee the coordination and submission of corrective action plans that are a result of audits.
- Monitor trends in audit findings to proactively address issues and prevent future discrepancies.
- Prepare and submit reports on audit findings to senior management and health plan representatives, as necessary.
Compliance and Regulatory Oversight:
- Ensure that clinical practices comply with all local, state, and federal regulations, including healthcare quality standards, patient privacy laws (HIPAA), and accreditation standards.
- Work closely with compliance officers to maintain and improve the facility’s overall compliance program.
- Assist with external inspections and audits, including those from regulatory bodies such as CMS, state health departments, or accrediting organizations.
Quality Improvement:
- Collaborate with leadership to develop and implement quality improvement initiatives to reduce clinical risk and improve patient care outcomes.
- Monitor performance data related to clinical risk management, safety, and audit results.
- Contribute to the development and implementation of action plans to address performance gaps identified through audits and incident reporting.
Incident Reporting & Data Analysis:
- Oversee the incident reporting system to track clinical incidents, risks, and adverse events.
- Review and analyze incident reports to identify patterns and potential systemic issues, ensuring corrective measures are taken.
- Generate regular reports on clinical risk data and trends to inform senior management decision-making.
- Bachelor’s degree in Nursing, Healthcare Administration, Risk Management, or a related field.
- Minimum of 6 years of experience in clinical risk management, preferably within an outpatient healthcare setting.
- Strong understanding of clinical processes, patient safety, healthcare regulations, and quality improvement methodologies.
- Knowledge of healthcare reimbursement and documentation requirements, including familiarity with audits and regulatory compliance (e.g., CMS, HIPAA).
- Experience in managing or overseeing health plan audits, including documentation review and audit response processes.
- Excellent communication and interpersonal skills, with the ability to work effectively with multidisciplinary teams.
- Strong analytical and problem-solving skills, with attention to detail.
- Ability to manage multiple projects and priorities in a fast-paced environment.
- Current California State Board RN license.
- Will be required to travel between all TrueCare sites and locations therefore California Driver’s License, proof of valid insurance and clean driving record required.
Desired Qualifications:
- Master's degree preferred in Healthcare Administration, Risk Management, or a related field.
- Certification in Risk Management (e.g., Certified Professional in Healthcare Risk Management – CPHRM) preferred.
- Competitive Compensation
- Competitive Time Off
- Low-cost health, dental, vision & life insurance
- Tuition Reimbursement, Employee Assistance program
TrueCare is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of race, color, religion, creed, national origin, ancestry, sex, gender, age, physical or mental disability, veteran or military status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state, or local law. Our goal is to promote and ensure authentic inclusion, belonging and support for all team members recruited or employed here. In the spirit of pay transparency, we are excited to share the base salary range for this position.
If you are hired at TrueCare, your final base salary (within the pay range), will be determined based on factors such as education, knowledge, skills, and experience. In addition to those factors, we believe in the importance of pay equity and consider the internal equity of our current team members when determining any final offer. Please keep in mind that the range mentioned above is the full base salary range for the role. Hiring at the maximum of the range would not be typical to allow for future and continued salary growth. We also offer generous benefits and retirement plans.