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Position SummaryCoordinates St. Mary’s Health System risk management functions to maximally assure that identification of risk exposure, assessment, appraisal, and loss prevention are carried out so that the institution remains safe for its patients, families, and employees. Identifies and limits legal exposures. Directly assists in the handling and defense of legal claims. Manages assigned portion of insurance policy portfolio.Job Responsibilities:· Participates as a member of appropriate committees and task forces assigned to improve quality, safety and to reduce organizational risk.· Develops statistical and qualitative reports on risk management trends and patterns and communicates this information effectively to appropriate audiences within the Health System· Develops annual goals for Risk Management in collaboration with the Covenant Director of Risk Management. Employs a vision to develop new concepts and solutions. Inspired to succeed and is driven to deliver on goals and expectations.· Ascertains that risks are minimized through follow up and actions on all regulatory/insurance survey report recommendations/deficiencies. Is aware of the fiduciary duties to identify, disclose and manage the organization’s risk.Adverse Events/ Claims – 20%· Evaluates all incidents for severity, frequency, and probability of financial loss, and reports as necessary to appropriate administration, committees, and personnel. Develops and maintains an incident reporting system by establishing a comprehensive incident reporting plan that establishes policies, educational programs, and reporting methods to the appropriate areas. Directs appropriate incidents to Medical Staff and Nursing peer review processes. Uses industry benchmarking to compare appropriate data.· Directs the risk investigation of all identified potentially compensable events (patient, visitor, employee, and product). Evaluates the investigation of all claim files on a routine basis in accordance with accepted standards.· Develops loss control measures relating to patient care complaints including, but not limited to, billing adjustments, access to medical care, and the provision of certain treatments when appropriate. Negotiates settlement of small claims within administrative authority.· Maintains chain of custody on all medical records with outstanding claims, and maintains all evidence, documents, and communications on legal cases in a confidential manner. Sequesters medical records as necessary.· Acts as the primary spokesperson for the hospital and health system to persons who have a complaint that may be considered a potentially compensable claim. Aids the PatientRelations Coordinator in analyzing patient complaints and directs inquiries to appropriate personnel.Insurance/ Legal Counsel – 20%· Presents summary information to outside legal counsel and Covenant Health Director of Risk Management with an opinion as to potential for litigation. Manages the documentation and computerized files of all claims.· Prepares, reviews, and presents all disbursements for claims.· Assists the agents for the excess insurance carrier providing general and professional liability coverage in active case review.· Acts as liaison with insurance carriers and coordinates and prepares materials necessary for renewal of insurance applications.Risk Programming – 20%· Develops and implements preventive risk management programs. Educates and trains staff in appropriate procedures, documentation, reporting, and follow-up in key areas of risk management interest. Is the organization’s expert resource in risk reduction and keeps abreast of trends in the industry.· Demonstrates knowledge and implementation of creative and innovative risk management processes.· Acts as liaison to outside litigation counsel in the management and investigation of filed lawsuits and related litigation processes. Understands the legal components of the risk management industry.· Trains and supervises risk management staff.· Serves as a resource to organizational staff on issues related to professional liability and other risks. Demonstrates role model behavior regarding proper customer satisfaction, conduct, confidentiality, complaint resolution, and problem solving.Policies/ Procedures/ Regulatory – 20%· Reviews and revises the Risk Management Plan and all Risk Management policies as needed and at least once every two years. Proactively recommends appropriate revisions to new or existing policies and procedures to eliminate/reduce risk and to prevent future occurrences.· Prepares all necessary documentation and promotes compliance with JCAHO regulations regarding areas of risk management responsibility, including but not limited to sentinel events and root cause analyses.· Promotes compliance with all applicable regulations including but not limited to the Safe Medical Devices Act (SMDA), Emergency Medical Treatment and Active Labor Act (EMTALA), and Health Insurance Portability and Accountability Act (HIPAA).· Oversees the implementation of an effective Organizational Integrity Plan including periodic review and revision of compliance related documents, ensuring follow up of compliance related audits and ensuring a mechanism for reporting of compliance related activity.Covenant Health Mission StatementWe are a Catholic health ministry, providing healing and care for the whole person, in service to all in our communities.Our Core Values:CompassionWe show respect, caring and sensitivity towards all, honoring the dignity of each person, especially the poor, vulnerable and suffering.IntegrityWe promote justice and ethical behavior, and responsibly steward our human, financial and environmental resources.CollaborationWe work in partnership, dialogue and shared purpose to create healthy communities.ExcellenceWe deliver all services with the highest level of quality, while seeking creative innovation.We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.
