Claim adjuster Jobs in Downey, CA

Job Title: Director, Risk Management & Patient Safety

Location: Downey, CA (Onsite)

Industry: Healthcare

Employment Type: Regular / Full-Time

Job Level: Director / Senior Director

Travel Required: No

Salary Range: $175,600 – $258,100 / year (No salary flexibility)

Relocation Assistance: Not Available

Visa Sponsorship: Not Available

Position Overview

The Director of Risk Management & Patient Safety oversees critical risk management projects and drives continuous clinical quality, patient safety, and regulatory compliance across acute care hospital operations. This leadership role is responsible for navigating complex healthcare risks—including cybersecurity, changing reimbursement structures, and evolving medical standards—while maintaining a culture of continuous learning, employee and patient health safety, and operational excellence.

Key Responsibilities

Risk Management & Patient Safety Oversight

• Direct comprehensive risk management efforts, establishing standards for root cause analysis (RCA), failure mode and effects analysis (FMEA), and proactive risk assessments in response to significant events, near misses, and good catches.
• Direct patient safety programs, hazard responses, and event management protocols; collaborate with executive leadership to improve patient flow, clinical support, and seamless care transitions.
• Oversee critical risk projects including healthcare cybersecurity vulnerabilities, reimbursement structure shifts, and the impact of medical science advancements on hospital performance.
• Establish standards for corrective action plans resulting from clinical record audits, claim denials, utilization reviews, and patient satisfaction surveys.

Infection Prevention & Control

• Oversee epidemiological investigations, outbreak containment protocols, and simulations of significant infection clusters or serious communicable disease concerns.
• Serve as a consultant on the infection control implications of hospital architectural design, renovation, and construction projects.

Regulatory Compliance & Survey Readiness

• Act as the primary subject matter expert and point of contact for regulatory bodies, government authorities, and external auditors during site visits and evaluations.
• Ensure continuous survey readiness across acute care departments and maintain compliance with local, state, and federal healthcare standards.
• Direct quality-of-care complaints and formal review processes, representing the organization at grievance meetings and overseeing preparations for sensitive patient case evaluations.

Clinical Quality Improvement & Data Analytics

• Establish organizational standards for data management, statistical analysis, and performance tracking across patient and employee safety programs.
• Utilize health databases, hospital discharge data, claims, and population health metrics to guide operational strategies and present targeted reports to executive stakeholders.
• Develop SOPs and clinical quality programs that align treatment protocols with population health needs (e.g., access to care, transportation, reducing missed appointments).

Leadership & Operational Management

• Oversee operations, resource allocation, and budget management across multiple units within the department.
• Recruit, develop, and retain a highly skilled workforce; mentor leaders, build collaborative internal networks, and establish performance management expectations.

Requirements & Qualifications

Must-Have Qualifications

• Active Registered Nurse (RN) Licensure (strongly preferred/required for key clinical oversight).
• Certified Professional in Healthcare Risk Management (CPHRM) certification (or ability to obtain within 24 months of hire; Certified Professional in Healthcare Quality [CPHQ] also considered).
• Recent Clinical Risk Management experience within an acute care hospital setting.
• Proven expertise in Infection Prevention Program oversight and Architectural Infection Control consulting.
• Demonstrated experience handling cybersecurity risk in a healthcare environment.
• Expertise in Root Cause Analysis (RCA) and Failure Mode and Effects Analysis (FMEA).
• Hands-on experience conducting Population Health Needs Analyses.

Minimum Education & Experience

• Education: Bachelor’s degree in Healthcare Administration, Nursing, Business Administration, Public Health, or a related field.
• Experience:
  • Minimum of 7 years of healthcare experience with a Bachelor’s degree (OR 10 years of directly related healthcare experience in lieu of a degree).
  • Minimum of 7 years in a leadership role (with or without direct reports).
  • Minimum of 2 years of experience managing operational or project budgets.
  • Minimum of 5 years of experience utilizing healthcare databases and advanced spreadsheets.
  • Minimum of 4 years of experience delivering clinical training or educational programs.

Core Competencies & Knowledge Areas

• Clinical & Healthcare Compliance: Health Care Policy, Health Care Compliance, Quality Improvement (QI), Quality Assurance, Evidence-Based Medicine.
• Risk & Process Management: Risk Assessment, Healthcare Data Analytics, Business Process Improvement, Project Management.
• Interpersonal & Strategic Leadership: Negotiation, Managing Diverse Relationships, Delegation, Consulting, Development Planning.