Director Risk Management

Description

THE ROLE

Executes area-wide risk management program in collaboration with Vice President Quality and Patient Safety (Northern California) and SJHS Risk Management. Responsibilities include risk identification systems, risk control, risk investigation and risk transfer. Works collaboratively with senior leadership, physicians and staff to reduce medical errors, grievances and complaints to improve patient safety and stay current on all federal and state regulations for healthcare risk management. Provides a continuous learning and just culture approach to the investigation and reconciliation of all patient safety events and patient feedback.

Works collaboratively with the Patient Experience Officer to ensure a well-coordinated and streamlined approach to the mutual goals of the Risk Management and the ministry Patient Experience priorities. Supervises other risk specialist, project manager and patient relations staff in the dept. Manages claim activities with third party administrators (TPA) and defense attorneys. Analyzes trends related to outcomes, improvement plans and reporting. Participates in appropriate committees, including the Ministry Boards. Exercises independent judgment and discretion and takes actions as needed based on knowledge of the organization, its policies, procedures, and personnel. Minimal supervision required.

Demonstrates the basic knowledge and skills (cognitive, technical, and interpersonal) necessary to identify age-specific patient needs, as related to risk identification, case review and process improvement. This includes patients such as neonatal, infant, child, adolescent, adult, and geriatric.

ESSENTIAL FUNCTIONS

• Investigates and analyzes actual and potentially compensable events within the organization and assures implementation of appropriate actions/interventions:
• Interviews employees, physicians and/or department managers using the Just Culture algorithm approved by the SJHS.
• Request medical staff review and arranges employee interview with third party administrator and/or attorney.
• Inspects property damage and documents uncorrected or uncorrectable damage to property or equipment. Sequesters any relevant evidence securely immediately on notification of event.
• Reports investigative findings and manages claims with insurance carrier, third party administrator, and/or attorneys.
• Prepares written reports of investigations in a timely and prioritized manner to the appropriate individuals.
• Compiles statistical data and generates subsequent reports:
• Keeps administration informed of serious events involving actual/perceived claim potential timely.
• Manages all patient feedback related to complaints and grievances and works collaboratively with Patient Experience Officer to ensure opportunities for service recovery or identification of preventive measures to ensure patient expectations and safety are secured in advance of discharge from the hospital or during their encounter with any of our inpatient/ outpatient services under the SRMH/PVH licenses.
• Prepares risk/patient safety reports for Committees/Sonoma and Health System Boards as requested and on routine schedule as required.
• Provides feedback to managers on risk reduction, risk elimination or risk education needs.
• Reviews scientific literature, rules and regulations that might be relevant to investigations and summarized in a literature review.
• Expert facilitator of Critical Event Investigations, Proactive Risk assessments and Identification of high hazards before events occur. Able to communicate critical learnings and safe best practices to all disciplines so that risk is mitigated and harm is avoided. Utilizes Collaborative Just Culture (JC) guide routinely in all investigations.
• Partners with Human Resources, Employee Assistance and Critical Incident Stress Management colleagues to assure care of the care giver are addressed for anyone who is involved in a medical error. Must also seek HR direction on employee/physician safety.
• Meets deadlines for system reporting requirements including outstanding patient safety reports, (RL), claims management and open Root cause Analysis Action steps.
• Reports summaries of claims information to Administration & Board of Trustees.
• Reviews & processes all Quality Assurance Notices:
• Identifies issues related to quality of care and forwards to appropriate leadership/personnel for further review.
• Shares pertinent information with Ministry Quality and Patient Safety committees.
• Identifies trends and reports to Medical Staff and/or Administration, as appropriate.
• Meets Monthly with Executive Management Team (EMT) and reviews all outstanding RCA action items.
• Meets Quarterly with Sonoma CEO to review claims and other risk reports as well as progress on RL event closures.
• Assures organizational compliance with licensing and accreditation and other regulatory agencies, guidelines and standards including Safe Medical Devices Act, CMS Conditions of Participation, the Joint Commission (TJC) California Dept. of Health (CDPH) and other State and Federal Laws.
• Contributes to hospital-wide educational programs on risk management/patient safety.
• Provides leadership for improving organizational risk management issues, including patient care, staff/physician safety and facility safety endeavors.
• Maintains knowledge of the facility's insurance coverage against liability loss. Provides summaries of the facility's insurance program and claims history upon request. Acts as a liaison with SJHS Risk and Insurance department, and supplemental carriers; completes insurance applications and responds to surveys; prepares material necessary for renewal of policies.
• Participates in state and national Risk Management Associations.
• Reviews proposed policies and programs, contracts and affiliations agreements which may have risk management impact and advises administration.
• Assists in disclosure of errors to patients and families as approved by CEO, department leaders and SJHS Risk Management.

QUALIFICATIONS

• Bachelor's Degree in Nursing or other healthcare related degree.
• Master's Degree; or J.D. if experience is acceptable for healthcare (preferred)
• On the job training and attendance at workshops and seminars by the ministry, SJH and external resources
• Upon hire: Certification in Risk Management or Healthcare Quality (preferred)
• 3 years in the field of health care risk management within an acute hospital setting or equivalent experience
• Experience reviewing and understanding health care metrics
• Management experience
• Legal or Investigative Experience (preferred)
• Healthcare Quality Management Experience (preferred)
• Current knowledge in nursing procedures, patient care, obstetric, surgical and medical procedures
• Ability to read and extrapolate clinical laboratory reports, medical records, radiology reports and other medically related documents in the EMR and in other relevant applications that contain patient information
• Working knowledge of relevant federal and state health care related legal statutes
• Ability to establish and maintain effective working relationships with personnel, medical staff, nursing staff, patients and guests
• Good communication skills in both verbal and written mediums, analytical and statistical skills, problem solving capability
• Strong Initiative/self-motivation skills
• Strong organizational, leadership & time management skills and the ability to meet deadlines and handle multiple priorities
• Ability to work effectively with distractions & minimal supervision
• Knowledge of computers and data entry skills necessary for report writing
• Proficient use of Microsoft Office.

About Providence

At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.

Requsition ID: 329767

Company: Providence Jobs

Job Category: Risk

Job Function: Legal/Compliance/Risk

Job Schedule: Full time

Job Shift: Day

Career Track: Leadership

Department: 7000 QUALITY ASSURANCE CA SOCAL

Address: CA Irvine 3345 Michelson Dr

Work Location: Providence Health System Office-Irvine

Workplace Type: On-site

Pay Range: $87.46 - $142.57

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.