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Job Description: A brief statement of the position, including the general job duties.
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Responsible for the development, planning, implementation and administration of an enterprise risk management program designed to reduce risk, injury, and potential exposures across the organization to improve health outcomes and service, increase patient safety, and reduce error in the healthcare process.
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Reports to
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Director–Litigation, Claims & Insurance
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Supervises
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Administrative Assistant in conjunction with General Counsel
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Ages of Patients
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Adult
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Geriatric
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Pediatric
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Blood Borne Pathogens
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Minimal/ No Potential
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Qualifications
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Education
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Required: Bachelors Degree
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Preferred: Nursing or other clinical degree
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Licensure/Certification
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Preferred: Certified Professional Health Care Risk Management (CPHRM)
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Experience
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Required: 5 years in Healthcare Risk Management
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Preferred: 10 years experience in Risk Management
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Specific Skills, Knowledge, Abilities Required
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A high level of interpersonal skills and communication ability are needed to effectively interact with and influence all levels of personnel, both within and outside the hospital, often in sensitive situations.
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Organizational skills with the ability to handle multiple tasks.
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Analytical ability needed to develop goals, plans, policies, and procedures, and to evaluate effectiveness of same.
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Supervisory and managerial skills necessary to direct the activities of a group of hospital employees.
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Knowledge of state and federal legislation.
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Knowledge of the litigation process.
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Knowledge of the insurance industry.
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Knowledge of the risk management process.
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Computer literate with all types of computer software.
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Essential Job Specific Responsibilities
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Clinical and Enterprise Risk Management
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- Implement and lead clinical risk management program to protect the interests of the hospital, clinics, and patients
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- Identify, investigate, analyze, and evaluate risk related events on a proactive basis through trend analysis of incidents, patient complaints, near miss events, reports etc.
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- Identify the most advantageous methods of correcting, reducing, or eliminating identifiable risks that may adversely affect patients, visitors, and employees
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- Provide guidance and recommendations on incident handling and risk management and escalate issues as necessary
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- Educate, advise and consult on risk management and mitigation best practices
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- Prevent patient harm by prospective consultation and working closely with Quality
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- Support ongoing clinical risk management/mitigation and quality improvement initiatives to resolve patient safety concerns
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- Implement strategies to mitigate events associated with patient harm
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- Identify remedial measures needed following an adverse event
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- Participate in RCA’s
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- Participate in weekly Incident Review Committee
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- Administer the Risk Hotline
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- Review all incident reports and follow up as needed
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- Take appropriate measures to reduce the cost of risk to the organization
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- Contribute to designing and implementing the enterprise-wide ERM program, including documentation of RM policies, procedures and standards
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- Collaborate to build effective relationships and establish credibility in order to advance risk management objectives
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- Facilitate appropriate disclosure conversations and assist in preparing other involved professionals for those conversations
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- Onboard new physicians, managers, and employees
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- Provide day to day advice and assistance to health system leaders, physicians, nurses, and social workers as concerns arise
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- Assist in management and administration of the insurance program
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Litigation and Claims Management
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- Identify potentially compensable events and work with clinical staff to obtain appropriate documentation
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- Identify equipment and evidence required for investigation and facilitate sequestration
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- Work with patients/families and visitors to resolve outstanding issues
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- Seek informal resolution with injured patients and visitors when appropriate
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- Collaborate with external legal counsel on litigated files, respond to discovery requests and assist in formulating defense strategies
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- Collaborate with TPA’s to ensure alignment with company guidelines and best practices in claim handling
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- Establish and monitor appropriate claim reserves and maintain claims files
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- Assist with patient complaints which have the potential to become compensable events
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- Assign counsel and manage Medical Board complaints for EMA physicians
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- Coordinate EMC and EMA depositions, subpoenas, law enforcement interviews etc.
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- Participate in arbitration, mediation, and settlement negotiations
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Located in the heart of the Coachella Valley, you have access to resort-style living and world-class amenities throughout Southern California.
