Healthcare Risk Management SME

Healthcare Risk Management SME

02 Nov 2022
Michigan, Southfield, 48037 Southfield USA

Healthcare Risk Management SME

Role Title: Healthcare Risk Management SME Location: Remote Full Time US citizens only Minimum years of work exp: 5 Years
Education: Bachelor's Degree in Nursing, Business/Management or a Healthcare related field.
Required Skills:

  • Certification in HRM (ASHRM) strongly preferred
  • Current, unencumbered RN licensure preferred
  • MHS/DHA experience preferred
  • Ability to effectively communicate at various levels within the organization (i.e., HQ, market, facility
  • Proficient in Microsoft Office tools
  • At least five years of experience in healthcare setting or with a provider of services to the healthcare industry
  • At least two years of job duties dedicated to healthcare risk management
Desired Skills:
Day-to-day Responsibilities:
  • Receive and record malpractice claim payments monthly, active duty death/disability cases and initiate the required clinical quality review process; correctly identify and process medical malpractice claims by legal outcome (payment) type and standard of care.
  • Process clinical, government administrative and criminal adverse action cases. In Accordance With (IAW) Department of Defense Instruction 6025.13, Medical Quality Assurance (MQA) in the Military Health System (MHS), Defense Health Agency Procedural Manual 6025.13, Clinical Quality Management in the Military Health System (DHA-PM 6025.13), and Air Force Instruction (AFI) 44-119, Medical Quality Operations.
Additional Update: Please refer to the CPHRM Certificate Holder List in the Information File section. You can first reach out to them and submit their profile. In case if you are approaching candidates who doesnt hold certification, then should be able to clear an exam which includes:
  • At least 5 years of experience in a health care setting or with a provider of services to the health care industry and
  • 3,000 hours or 50 percent of full-time job duties within the last three years dedicated to health care risk management in a health care setting or with a provider of services (e.g. consultant, broker, or attorney) to the health care industry.
  • Note:
    Public Trust or ability to acquire W2 candidates only US citizens only Right to Hire - Yes

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