Risk Manager

Spectrum Health & Human Services

Agency Profile: Spectrum Health & Human Services respectfully partners with adults, children and families as they recover from behavioral, emotional, mental health and/or substance related disorders by offering individualized and meaningful opportunities of hope, empowerment and support to achieve self-defined improvements in their quality of life.

Full-Time 227 Thorn Ave, Orchard Park NY

JOB DESCRIPTION:

The Risk Manager leads and coordinates Spectrum Health and Human Services’ agency-wide risk management process, partnering with leadership to identify and mitigate organizational risks. The position also supports compliance investigations, corrective actions, and ongoing monitoring in collaboration with the Compliance Officer and Compliance Manager.

ESSENTIAL FUNCTIONS: 

• Own and administer the agency’s risk assessment process, including the development, implementation, and ongoing maintenance of a consistent methodology for identifying, evaluating, prioritizing, documenting, and monitoring organizational risk.
• Partner with departmental leaders to conduct routine and event-driven risk assessments, develop appropriate controls and mitigation strategies, and monitor actions through completion.
• Maintain the organizational risk assessment and mitigation plans, including target completion dates, control measures, and documentation of residual risk following mitigation activities.
• Assess current and emerging operational, regulatory, financial, workforce, technology, and reputational risks; evaluate existing controls and mitigation measures; and identify future risk management needs.
• Monitor internal and external developments that may create new or increased organizational risk and recommend when additional assessment, escalation, mitigation, or executive review is warranted.
• Review regulatory guidance, audit activity, funding-source requirements, payer expectations, contractual obligations, and organizational experience to identify areas of current or emerging risk.
• Partner with key departments to identify documentation, billing, medical necessity, credentialing, service delivery, and regulatory risks and recommend appropriate monitoring or corrective action.
• Monitor OMIG and OIG work plans, guidance, notices, alerts, and enforcement activity; assess potential organizational impact; and coordinate with Compliance and operational leadership to address identified risks.
• Identify potential areas of compliance vulnerability and organizational risk in collaboration with responsible departments to develop corrective action and mitigation plans.
• Partner with contract owners and responsible departments to assess risks associated with vendors, contractors, subcontractors, business associates, consultants, and external partners.
• Develop key risk indicators and metrics to evaluate identified risks and corrective actions to support the effectiveness of the Compliance Program.
• Provide risk-assessment findings and metrics to the Compliance Officer and senior leadership to inform the Compliance Program work plan, internal monitoring priorities, training needs, policy development, and resource allocation.
• Receive, document, triage, and assist in investigating complaints, reported concerns, hotline matters, and potential compliance issues assigned by or in coordination with the Compliance Officer.
• Conduct or support fact-finding activities, including interviews, document review, data review, chronology development, and collection and preservation of relevant information.
• Prepare objective investigation summaries, risk analyses, findings, and recommendations while maintaining appropriate confidentiality and documentation.
• Maintain a centralized mechanism for tracking complaints, compliance concerns, corrective actions, and closure determinations under the formal authority of the Compliance Officer.
• Conduct or coordinate risk-based reviews and monitoring activities to evaluate compliance with applicable federal, state, local, payer, contractual, grant, and other funding-source requirements.
• Use risk assessments, complaint and investigation trends, external findings, prior audit results, regulatory changes, and leadership input to recommend risk-based monitoring priorities.
• Partner with departmental leadership to develop control measures and monitoring plans that address identified vulnerabilities.
• Partner with Human Resources, Training, Compliance, Quality Improvement, and operational leadership to identify risk-related training needs based on risk assessments, complaints, investigations, monitoring results, and regulatory changes.
• Contribute risk-management content to new-hire orientation, supervisor development, annual compliance education, and department-specific training.
• Facilitate cross-departmental communication when a risk involves multiple operational areas or requires coordinated mitigation.
• Promote a culture in which employees and leaders proactively identify, report, discuss, and address risk without fear of retaliation.
• Support the Compliance Manager in administering and monitoring the OIG exclusion and sanction screening process.
• Use findings from risk assessments, investigations, complaints, regulatory changes, and corrective-action reviews to recommend policy revisions related to federal or state compliance requirements.
• Partner with program leadership to incorporate business continuity, emergency preparedness, cybersecurity, workforce disruption, and service-continuity risks into the risk assessment.
• Assure the standards of a high performing team member are followed and modeled on a daily basis.

SKILLS:

• Experience conducting organizational risk assessments, investigations, and corrective action or risk mitigation activities strongly preferred.
• Strong knowledge of healthcare laws and regulations.
• Ability to work effectively with people from a variety of cultural and ethnic backgrounds.
• Skilled in the use of computers and related software applications.
• Must be a strategic thinker and insightful decision maker with ability to analyze and solve problems.
• Ability to maintain confidential information.
• Strong facilitation and collaboration skills to build cross-functional partnerships to drive results.
• Strong written, verbal, and analytical research skills, to synthesize information and inform outcomes.

EDUCATION AND EXPERIENCE REQUIREMENTS:

• Bachelor’s degree required in healthcare administration, business, finance, risk management, compliance, social work, or a related field. Master’s degree or other advanced degree preferred.
• Minimum of five years of progressively responsible experience in healthcare or human services involving risk management, investigations, auditing, or related functions preferred.
• Must possess a valid Driver’s License with an acceptable driving record

COMPENSATION:

• $51,784 - $66,025 Annually