Manager of Clinical Risk Management (71487)

Curana Health is a provider of value-based primary care services for the senior living industry, including skilled nursing facilities, assisted & independent living communities, Memory Care units, and affordable senior housing sites. Our 1,000+ clinicians serve more than 1,500 senior living community partners across 33 states, and Curana participates in various innovative CMS programs (including owned-and-operated Accountable Care Organizations and Medicare Advantage plans). With rapid year-over-year growth since our founding in 2021, Curana is setting a new standard in innovative care delivery for seniors with high-risk, complex clinical needs, many of whom have been historically underserved by the health care system. Our mission: To radically improve the health, happiness and dignity of senior living residents.

SUMMARY

Reporting to the Chief Legal Officer, the Manager of Risk Management oversees the Clinical Risk Management Program to safeguard the Company and its patients, providers, and employees. The Manager of Risk Management proactively identifies, evaluates, and mitigates risks to enhance patient safety, ensure quality care, and reduce organizational costs through effective risk management, claims administration, and insurance procurement.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Insurance Procurement and Management

• Collaborates with insurance brokers to evaluate, negotiate, and secure appropriate coverage for professional liability, general liability, property, vehicle, flood, EPL, crime, D&O, and fiduciary insurance.
• Maintains schedules for insurance coverage, including physician/APP and locum tenens, property, vehicle, and flood insurance locations.
• Coordinates quarterly and annual claim reviews with brokers and carriers for workers’ compensation and professional liability.
• Reviews insurance requirements for leases, RFPs, and contracts, obtaining certificates of liability insurance for providers, centers, landlords, vendors, employers, and other third parties as needed.
• Oversees participation in state-specific programs (e.g., Indiana Patient Compensation Fund, Pennsylvania Patient Compensation Fund, Ohio Workers Compensation, and Washington Workers Compensation).

Claims Management

• Develops and implements claims administration policies and procedures.
• Maintains a comprehensive database for all claims, incidents, and loss runs.
• Investigates claims to assess compensability and inform preventive measures.
• Files and tracks claims with carriers, ensuring timely resolution.
• Assesses potential liability and loss probability for incidents, claims, and legal actions.
• Ensures completion of incident reports, investigations, and carrier communications.
• Coordinates with insurance carriers and outside counsel to resolve claims, and facilitates settlements as appropriate.
• Supports litigated claims by assisting attorneys, coordinating with carriers, and preparing for legal proceedings.
• Assists clinical staff, management, and carrier in litigated claims and assists attorneys as needed.
• Develops and updates the Insurance/Claims Guide, Fleet Safety Program, and Return to Work Program.

Risk Management

• Develops and maintains systems for identifying, investigating, and tracking risks and incidents to enhance patient and workplace safety.
• Analyzes incident patterns, maintains statistical data, and screens reports for loss control.
• Evaluates risk reduction strategies on a regular basis and recommends actions to mitigate risks.
• Develops and reviews organizational policies on risk management and patient safety.
• Serves as a subject matter expert, consulting with clinical teams on risk management and patient safety bes