Clinical Risk Manager - Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Actively participate in the overall risk management program for assigned CDOs. Promotes a culture of safety in all interactions with staff and clinicians at assigned CDOs, by focusing on development of positive relationships and non-punitive investigations and solutions to reported events. Responsible for proactively responding to adverse event reports, working with leaders and SMEs at assigned CDOs to investigate and resolve events related to patients, visitors, clinicians and staff. Analyze and assess data collected through the adverse reporting system to identify actionable trends and ensure proactive steps are taken to mitigate risk. Provide consultation as needed to clinicians and leaders at assigned CDOs for any risk management concerns that may arise.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Adverse Event (AE) Reporting
  
  
  
  
  • Coordinate with assigned Risk Analyst in monitoring AEs daily for assigned CDOs
  • Confirm each AE is acted on, including complete documentation with the electronic reporting system before closing the file
  • Recommend ALEA calls in coordination with Risk Analyst and in consultation with Risk Attorney
  • Timely identify and report claims and PCEs to PL Litigation Counsel
  • Engage with appropriate Subject Matter Experts (SMEs) in event reviews (e.g., compliance, human capital, privacy, etc.)
  • Analyze trending reports from the AE reporting system, identifying actionable trends and recommending appropriate corrective actions
  
  
  
  
• Investigations
  
  
  
  
  • Coordinate and actively lead investigations of adverse event (AE) reports, ensuring appropriate follow up and investigation is completed and documented, and that each AE is resolved
  • Assess events for potential liability risks and communicate with litigation team regarding any potentially compensable events (PCEs)
  • Lead investigations related to high severity and/or high frequency events, involving Director and Clinical Performance leadership as appropriate
  • RCA: Manage and lead Root Cause Analysis (RCA) meetings when appropriate, working cooperatively with involved leaders and guiding progress toward resolution of RCA * ALEA: In coordination with Risk Attorney, participate in ALEA (Attorney
  • Led Event Analysis) calls; investigate and follow up on outstanding items identified in ALEA calls and coordinate conversations with SMEs and involved clinicians regarding the event discussed
  
  
  
  
• Consulting
  
  
  
  
  • Provide advice, consultation, and support for clinical risk issues to staff, clinicians, and leadership at CDO
  • Engage and coordinate with appropriate SMEs in responding responses to consult requests (e.g., privacy, compliance, HC)
  • Review and recommend changes to CDO policies when appropriate
  
  
  
  
• Mitigation
  
  
  
  
  • Recommend and assist with development of corrective action plans or system improvements that may be necessary
  • In consultation with Risk legal resources and local CDO leadership, recommend updates to policies, procedures and systems for CDOs based on the results of investigations
  • Actively participate in the creation and education regarding risk toolkits to identify and mitigate losses
  • Review with Director any recommended process changes for consideration of any risk of loss to organization, and for consideration of whether wider implementation to other Optum CDOs may be warranted
  • Analyze trending reports from RLDatix to proactively identify risk reduction opportunities and to design and implement appropriate interventions
  • In coordination with Risk Analyst, communicate with patients when demands for compensation have been made to collect information and communicate to appropriate resources, including PL Litigation Counsel, Risk Attorney, and Business Attorney
  
  
  
  
• Training and Education
  
  
  
  
  • Participate actively in the content planning, coordination and presentation of risk management education programs for staff and providers at CDOs
  • Conduct medical and risk management research
  • Participate in external risk management training to maintain and advance knowledge, skill set, and networking opportunities
  
  
  
  

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Experience working in a matrixed environment
• Experience using clinical risk management software to manage events
• Proficiency in MS Word, Excel, PowerPoint and Outlook
• Demonstrated ability to communicate effectively
• Occasional Travel up to 10%

Preferred Qualifications:

• RN or JD
• Certified Professional in Healthcare Risk Management or prior risk-related education

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.