UNIV - Clinical Risk Manager (Registered Nurse) - Insurance Services

UNIV - Clinical Risk Manager (Registered Nurse) - Insurance Services

The Insurance Services Clinical Risk Manager supports the Insurance Services Director of Clinical Risk Management by conducting frontline discovery, evaluation, and documentation of clinical events involving healthcare providers across MUSC and the MUSC Health System including the RHN, MUSCP and affiliates, and MUSC Health Affiliates (collectively call the MUSC Enterprise). This role performs medical record reviews, assists in preliminary event assessments, prepares case summaries, supports professional liability processes, and facilitates communication with internal stakeholders. The Clinical Risk Manager collaborates with hospital risk and quality teams, internal counsel, and clinical departments to promote patient safety, reduce clinical risk exposure, and improve system wide learning. The position requires strong analytical skills, excellent communication, and the ability to manage sensitive clinical information with professionalism and discretion.

Responsibilities

• Conducts timely and objective reviews of clinical events with potential for professional liability exposure, focusing on identifying provider involvement, clinical concerns, and factors that may contribute to a future claim or litigation.
• Performs medical record review and event reporting analysis to determine whether an incident may require escalation for claims consideration.
• Prepares concise case summaries highlighting potential liability issues, documentation gaps, and patient outcome concerns for Director review.
• Assists with root cause analysis activities in collaboration with Hospital Risk and Quality partners.
• Supports early identification of trends or recurring risk factors that could increase exposure to claims or legal action.

• Assists the Director, insurance representatives, and external counsel in gathering clinical documentation relevant to professional liability events.
• Coordinates discovery?related tasks, including obtaining records, clarifying provider involvement, timelines, and clinical facts.
• Prepares exposure summaries, provider involvement reports, and supports communication of claims?related updates to internal stakeholders.
• Maintains accurate case files in alignment with Insurance Services and legal requirements.

• Summarizes clinical risk issues, case details, and recommendations for Director review.
• Communicates routine clinical risk trends, documentation needs, and follow?up tasks with hospital partners, clinical departments, and operations staff.
• Facilitates timely escalation of clinical concerns to the Director or senior leadership as appropriate.
• Supports organizational initiatives related to patient safety, quality improvement, and regulatory readiness.

• Assists in developing and delivering clinical risk management education for providers, residents, and clinical teams.
• Supports implementation of targeted risk mitigation strategies and safety interventions.
• Promotes a culture of transparency and learning throughout clinical departments.

• Maintains accurate, complete, and high?quality data within the Risk Management Information System (RMIS).
• Ensures timely entry, tracking, and updating of clinical events and supporting documents.
• Generates routine reports and dashboards for trend analysis and leadership review.
• Identifies workflow or data integrity concerns and collaborates with IT or Insurance Programs to troubleshoot.

Minimum Requirements: A bachelor's degree in Nursing and four years relevant experience. Strong analytical, writing, and critical thinking skills. Ability to maintain confidentiality and manage sensitive clinical information. Excellent interpersonal and communication skills.

• RN clinical licensure.
• Experience with risk management, quality improvement, patient safety, claims, or legal processes.
• Familiarity with Root Cause Analysis (RCA), Failure Mode & Effects Analysis (FMEA), Just Culture principles, and national patient safety standards.
• Experience with RMIS platforms.

• Clinical judgment and ability to interpret medical records.
• Strong organizational skills and attention to detail.
• Ability to work independently while supporting team objectives.
• Customer?focused and responsive to internal stakeholders.
• Professionalism when interacting with providers, leaders, and legal partners.

Physical Requirements: (Note: The following descriptions are applicable to this section: Continuous - 6-8 hours per shift; Frequent - 2-6 hours per shift; Infrequent - 0-2 hours per shift) Ability to perform job functions in an upright position. (Frequent) Ability to perform job functions in a seated position. (Frequent) Ability to perform job functions while walking/mobile. (Frequent) Ability to work indoors. (Continuous) Ability to work outdoors in all weather and temperature extremes. (Infrequent) Ability to work in confined/cramped spaces. (Infrequent) Ability to perform job functions from kneeling positions. (Infrequent) Ability to squat and perform job functions. (Infrequent) Ability to perform 'pinching' operations. (Infrequent) Ability to fully use both hands/arms. (Frequent) Ability to perform repetitive motions with hands/wrists/elbows and shoulders. (Frequent) Ability to reach in all directions. (Frequent) Possess good finger dexterity. (Continuous) Ability to maintain tactile sensory functions. (Continuous) Ability to lift and carry 15 lbs., unassisted. (Infrequent) Ability to lift objects, up to 15 lbs., from floor level to height of 36 inches, unassisted. (Infrequent) Ability to lower objects, up to 15 lbs., from height of 36 inches to floor level, unassisted. (Infrequent) Ability to push/pull objects, up to 15 lbs., unassisted. (Infrequent) Ability to maintain 20/40 vision, corrected, in one eye or with both eyes. (Continuous) Ability to see and recognize objects close at hand. (Frequent) Ability to see and recognize objects at a distance. (Frequent) Ability to determine distance/relationship between objects; depth perception. (Continuous) Good peripheral vision capabilities. (Continuous) Ability to maintain hearing acuity, with correction. (Continuous) Ability to perform gross motor functions with frequent fine motor movements. (Frequent)

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.