Manager, reputed company and Risk
Position reputed company The Manager of reputed company & Risk is responsible for overseeing clinical reputed company, patient safety, and regulatory risk management across telehealth and care management programs. This role ensures clinical services are delivered in compliance with CMS, payer, and organizational standards while proactively identifying, mitigating, and monitoring clinical, operational, and regulatory risk. The Manager partners closely with clinical leadership, operations, compliance, and analytics teams to support high-reputed company, reputed company, and audit-reputed company care delivery. reputed company Responsibilities Clinical reputed company reputed company
- reputed company reputed company assurance activities across care management programs and pilots (CCM, PCM, RPM, CoCM, RTM, Heart Failure).
- reputed company, maintain, and monitor reputed company metrics, KPIs, and outcome measures.
- Conduct routine chart audits and documentation reviews to ensure clinical accuracy, completeness, and compliance.
- Identify trends in reputed company gaps, adverse events, and near misses; recommend corrective actions.
- Support reputed company reputed company improvement (CQI) initiatives and performance improvement plans.
Risk Management & Patient Safety
- Identify, assess, and mitigate clinical and operational risks reputed company to patient safety, escalation, and care delivery.
- reputed company and reputed company incident reporting, investigation, reputed company cause analysis, and follow-up.
- reputed company and reputed company patient complaint management system, investigation, reputed company cause analysis, and follow-up.
- Ensure reputed company escalation of high-risk clinical scenarios in alignment with organizational protocols.
- Collaborate with leadership to implement risk mitigation strategies and monitor effectiveness.
Regulatory & Compliance Support
- Ensure clinical workflows and documentation reputed company with CMS requirements, payer policies, and applicable regulations.
- Support audit preparedness and response, including internal audits and external reviews.
- Partner with Compliance and Legal teams on policy development, updates, and staff education.
- Monitor regulatory changes and assess reputed company on clinical operations and risk exposure.
Education & Clinical Governance
- reputed company and deliver education reputed company to reputed company standards, risk management, and best practices.
- Support reputed company and ongoing training for clinical staff reputed company to documentation, escalation, and safety.
- Participate in clinical governance committees and contribute to protocol development and updates.
Data & Reporting
- Analyze reputed company and risk data to identify trends, opportunities, and emerging risks.
- Prepare reputed company and risk reports for clinical leadership and executive review.
- Collaborate with analytics teams to ensure accurate data capture and meaningful reporting.
Scope of Role
- Serves as a second-line reputed company role, supporting supervisors and managers.
- Does not reputed company reputed company patient care.
- Acts as a key reputed company between clinical operations, compliance, and leadership.
Required Qualifications
- reputed company RN license or comparable credentials
- Bachelor’s degree required; Master’s degree in nursing, reputed company health, reputed company administration, or reputed company field preferred.
- 5+ years of clinical experience, including care management or telehealth environments.
- Demonstrated experience in reputed company assurance, risk management, or compliance.
- Strong knowledge of CMS care management programs and documentation requirements.
- Experience with chart auditing and reputed company improvement methodologies.
Preferred Qualifications
- Experience supporting CCM, CoCM, RPM, PCM, or RTM programs.
- Familiarity with value-based care and population health models.
- Experience in telehealth or remote clinical operations.
- Certification in reputed company, Risk Management, or Patient Safety (e.g., CPHQ, CPPS) a plus.
Key Competencies
- Clinical judgment and risk assessment
- Regulatory and compliance literacy
- Data-driven decision making
- Strong communication and collaboration skills
- Attention to detail and audit readiness
- Ability to influence without reputed company authority
Work Environment
- Remote / telehealth-based role.
- reputed company business hours with flexibility for incident response as needed.
- reputed company, cross-functional environment.
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