Risk Management Specialist

Risk Management Specialist
Mortality Review/Quality Management Team
Critical Incident Management Unit
Office of Long-Term Living


Bachelor's degree in human services or business area or 3-years' experience in a related field.
Minimum of one (1) years' experience with Incident Management/Risk Management within the human services field, quantitative analysis and reporting is preferred.


The incumbent must possess the following knowledge and experience:

• Participant risk. What places participants at risk; how it is discerned; what risk management is at the individual participant level and broader population-based level; how risk management would be applied in individual cases and how it would be applied systemically, population-based evidence; determining relationships/patterns for risk between individuals versus patterns of risk across a population;.

• Proficiency in case management, in particular for measures utilized to improve health outcomes for at-risk populations

• Basic knowledge of statistics and statistical analysis

• Basic knowledge of epidemiology

• How to chart/graph data

• Advanced computer skills including use of Microsoft Office software and statistical software

• Advanced critical thinking and problem-solving skills

Role Description


This position is in the Critical Incident Management Unit, Division of Participant Supports, Bureau of Coordinated and Integrated Services within the Office of Long-Term Living (OLTL). The incumbent is assigned to a team tasked (1) to ensure that quality, effective, and efficient Home and Community-Based Services (HCBS) are provided to participants in their communities (through Community Health Choices waiver -CHC- and Fee for Service -FFS- programs); (2) to ensure that events that resulted in risk to the participants health, safety, and welfare are reported, investigated, and addressed according to agency policies and procedures; (3) to ensure all Unit activities are aligned with the Money Follows the Person's (MFP) initiatives.


Description of Duties


Perform case reviews and record reviews in order to provide consultation and technical assistance to Managed Care Organizations (MCO), Service Coordination Entities (SCE), Providers, and other agencies to assist with mitigation of participant risk.


Serve as liaison between state protective service agencies, MCOs, SCEs and the internal Critical Incident Management staff in coordinating case reviews and determining whether deficiencies exist in order to implement corrective actions. Manage protective services report of need notifications related to program participants and providers enrolled with the OLTL.


Coordinate information sharing with appropriate parties, provide technical assistance to other agencies, and ensure resolution of high profile and sentinel events.


Assist the clinical staff/registered nurses in the completion of mortality reviews by requesting and researching case-specific information, reviewing documentation from MCOs, SCEs, or providers, and tracking all activities to ensure appropriate follow up.


Complete trend analyses, collect and compile completed mortality reviews aggregated by calendar year to compare findings with the national health statistics for mortality and the Department of Health mortality health statistics and develop and implement preventative training program proposals to address impactful negative findings from trend analysis and mortality reviews.


Work with law enforcement agencies including the Office of the Attorney General to explain program policies, regulations, and standards. In coordination with the Unit's Review and Evaluation Nurse, ensure notification to appropriate authorities related to incidents of abuse and neglect of care-dependent persons.


Perform data integrity activities and coordinate record correction activities for MCOs, SCEs, and providers.


Participate in information system technology requirement and design sessions. Perform user acceptance testing of IT applications.


Conduct data analytic activities by analyzing and evaluating incident report data and developing comprehensive reports. Develop, update, and refresh data reports ongoing.


Utilize program office applications and databases such as Enterprise Incident Management (EIM), Home and Community Services Information System (HCSIS), WellSky, and Client Information System (CIS/eCIS), in order to manage oversight and monitoring activities. Utilize Excel and other statistical software, Word, and Power Point.


Communicate with FFS or CHC Waiver representatives to ensure health and welfare.
Develop and maintain a tracking system to identify patterns associated with negative participant health and welfare outcomes.
Participate as a member of workgroup, committees, and project teams specific to the subject area of incident and risk management as well as protective service management.


Apply project management principles to further project and initiatives as assigned.


Essential Functions

1. Be knowledgeable of medical conditions and terminology.

1. Be knowledgeable of physical disabilities, associated limitations to Activities of Daily Living (ADLs), Instrumental ADLs, and relevant supports.

1. Be proficient in risk identification, mitigation and case management within the realm of human services at an individual and broader population based level

1. Understand OLTL Medicaid Waivers and Act 150 program, regulations, policies, and procedures.

1. Be technology-savvy and able to work remotely using videoconference and telephonic platforms. The Critical Incident Management Team is currently on part time teleworking status.

1. Be able to work independently, self-initiator.

1. Organize and deliver presentations.

1. Ability to prioritize tasks.

1. Possess advanced critical thinking and problem-solving skills.

1. Be able to effectively communicate both orally and in writing.

1. Understand and interpret local, federal, and state laws as relevant.

1. Possess working knowledge of or advanced ability to learn Microsoft Office suite, Home and Community Services Information System (HCSIS), WellSky, and Client information system (CIS/e-CIS).

1. Travel independently with overnight stays, without available public transportation

Reference Material:






All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.