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.Under the general supervision of the Clinical Risk Manager, the Risk Analyst is responsible for actively supporting the national risk management program. Job responsibilities include promoting a culture of safety in all interactions with staff and clinicians, developing positive relationships and coordinating non-punitive investigations and solutions to reported events. Responsible for monitoring adverse event reports and working with Clinical Risk Manager and accountable leaders to investigate reports related to patients, visitors, physicians and employees. Uses critical thinking and problem-solving skills to analyze and assess data collected through the adverse event reporting system. Collaborates with Clinical Risk Manager counterpart to address trends identified through analysis of data collected, and to investigate specific individual adverse events with goal of identifying corrective actions on a system level.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
Monitor AEs daily and escalate significant AEs to Clinical Risk Manager (CRM)
Confirm AE is acted on, documentation is complete, and AE is closed in electronic reporting system
Recommend attorney lead calls in consultation with CRM
Identify to CRM any patient complaints with a demand for compensation related to harm/injury
Coordinate involvement of appropriate subject matter experts (SMEs) in event reviews (e.g., compliance, human capital, privacy, etc.)
Create and analyze reports from the AE reporting system; identify trends in AE reporting and escalate to RM (e.g., high frequency of events for one site, event type, multiple AE per provider)
Investigations
Gather medical records and compose medical treatment timelines for CRM led investigations
Interview clinicians and staff involved in event at the direction of CRM
Collect and summarize any policies/procedures that may be related to AE
Follow action items on Root Cause Analysis checklist as assigned by CRM
Follow action items on attorney led investigative calls as assigned by CRM
Consulting
Receive and respond to CRM consultation calls from clinical teams, operations, and patients, involving RM as appropriate
Triage phone calls to appropriate SME (e.g., privacy, compliance, HC)
Collect, review, and recommend changes to policies and procedures when required/requested
Mitigation
Review AE for opportunities to mitigate loss or proactively prevent future losses
Participate in proactive risk reviews at the direction of CRM (e.g., FMEA)
Participate in the development of risk toolkits to identify and mitigate losses
Draft professional liability (PL) reports of potentially compensable events (PCEs), claims, or lawsuits and any correlating material to provide to PL Litigation Counsel
Communicate with patients when demands for compensation have been made to collect information on claim and to communicate resolution determined by PL Litigation Counsel, with Risk Attorney, Business Attorney, and CRM
Training and Education
Participate in educational and training in-services
Participate in external CRM training to 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:
Nursing license (RN or LPN), or commensurate clinical and/or claims handling experience
Knowledge of Microsoft Word, Access, Excel and the ability to learn and navigate proprietary database systems
Ability to perform internet and other database searches for research
Ability to analyze and evaluate medical claims
Preferred Qualification:
Knowledge of managed care
Statistical analysis skills
Ability to prioritize and respond quickly to high-risk issues
Good organizational skills
Good interpersonal, verbal and written communication skills
Ability to work independently
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for this role is $58,300 to $114,300 annually. 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.