Risk Manager

Risk Manager

JOB SUMMARY:

·         Under the leadership of the Director of Quality/Risk, the Risk Manager manages the operation of the organization-wide Risk Management and Patient Safety programs and provides guidance to clinical staff.  The Risk Manager develops and maintains systems within the organization to detect, monitor, prevent, organize, measure, investigate, report, and manage patient adverse events, malpractice claims, incident reports and other indicators of potential patient harm. 

NMC’s key aims in this area are to be on the leading edge of improving health outcomes and service, increasing patient safety and reducing error in health care processes.  This position will be vital to accomplishing these objectives.

PRE-REQUISITES:

• Education:  Bachelor's degree in Nursing or related field required.  A minimum of 5 years clinical experience in a hospital setting preferred. Certified Professional Healthcare Risk Manager (CPHRM) to be obtained no later than 5 years after hire.Skills:

  o    High energy, organized, persistent and creative individual with strong communications, interpersonal and systems thinking skills. (critical thinking skills)

  o    Detail Oriented and ability to maintain meticulous records.

  o    Proven ability to management experience including a thorough understanding of QI processes, tools and techniques, quality measurement and reporting, TJC standards, Board of Registration in Medicine and Department of Public Health regulations, root cause analysis and preventive risk management strategies.

  o    Computer skills; ability to work with databases.

  o    Knowledge of electronic event reporting product and data management systems, preferred?

  o    Able to function effectively, independently, and efficiently in a stressful and dynamic work environment.

  o    Excellent Communications skills; ability to talk with patients/families, legal counsel, clinicians, executive level positions to discuss risk and mitigation strategies.

  o    Analytic skills involving use of data and statistics.

  o    Develop Risk Management focused education programs for key stakeholders.

• RELATIONSHIPS:
• Reports To:
• Director, Quality/Risk
•  
• Other Contacts: 
• Hospital staff, patients, visitors, vendors and providers

SCOPE:

• Machinery or Equipment Used:
• Computer and basic office equipment
• Physical Demands:
• Primarily sedentary work with some walking and light physical effort.  Requires manual dexterity, visual acuity and mobility.
• Working Conditions: 
• Occasionally subjected to irregular hours and pressure due to multiple tasks and projects.
• Required Protective Equipment:
• Appropriate PPE as the situation dictates.

ESSENTIAL FUNCTIONS:

Essential Function

1. Proactively evaluate areas of organizational risk based on internal assessment and external  benchmarking; and implement strategies and policies, which promote patient and staff safety.
2. Promote the organization-wide occurrence reporting process including, trending and reporting of results, identification of problem prone areas and the facilitation of prevention initiatives.
3. Evaluates all organizational incidents for severity, frequency, and probability of financial loss.
4. Direct the investigation of all potentially compensable events, (preventable adverse events).
5. Lead the review of serious occurrences requiring Root Cause Analysis or Failure Mode & Effects Analysis. In collaboration with Quality/Risk Director, disseminate lessons learned and process improvement plans effectively throughout the organization.
6. Meet regularly with Executive, Medical and Service Line Leaders to provide detailed reports on all serious incidents, claims and risk-related issues.
7. Respond to sentinel events and other serious occurrences and provide expert advice in the management and reporting of such events to administrative and clinical leadership and staff.
8. Conduct immediate/appropriate response to any serious occurrence/complaint representing actual or potential patient, visitor, and/or employee injury. Monitor and take subsequent actions to assure learning, compliance, and documentation
9. Analyze all statistical reports and advisories that identify risk management and patient safety patterns and trends for leadership, applicable committees, and the Joint Hospital Governing Board.
10. Give an account of all potential/actual claims to necessary parties in a timely fashion. Ensure maximum protection from discovery of all such materials.  Coordinate claims investigation and legal defense processes. Refer non-malpractice medico-legal issues and cases to hospital counsel and coordinate communication of results.
11. 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.
12. Serve as liaison to external regulatory agencies for purposes of patient and physician reporting, event investigation and response, including the Department of Public Health and/or Joint Commission.
13. 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.
14. Promote Risk Management and Patient Safety programs throughout NMC to all staff and physicians, in conjunction with the Quality/Risk Director.
15. Keep up to date with new and revised state and federal regulations and statutes related to hospitals and patient care. Review and evaluate related policies and procedures and recommend revisions as needed.  Create for approval, new policies as needed.
16. Actively participate in a variety of committees within the hospital as assigned to improve quality, safety and to reduce organizational risk.
17. Reviews and revises the Risk Management Plan and all Risk Management policies on an annual basis.
18. 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.
19. Assists the agents for the excess insurance carrier providing general and professional liability coverage in active case review.
20. Assists CFO with determining limits of liability and ensuring that organizational finances are available to pay for the cost associated with loss when risk control techniques have failed.