Risk Manager

Job Overview

JOB DETAILS

REQUIREMENTS

• Bachelor’s Degree Required
• Master’s Degree Preferred
• At least seven (7) years experience as a clinical provider or working in an academic medical center performing legal or patient safety activities. Required

• Excellent oral and written communication skills.
• Analytical skills.
• Proficient in Microsoft Word and Excel; proficiency with Microsoft PowerPoint desirable.
• Able to handle and organize multiple tasks.
• Able to work in a fast paced environment.
• Good judgment and the ability to offer practical advice.

RESPONSIBILITIES

• Clinical Risk Management and Compliance
• Coordinates orientation of new employees to the Risk Management and Office of General Counsel departments.
• Demonstrates role model behavior regarding proper customer satisfaction, conduct, confidentiality, complaint resolution, and problem solving.
• Cultivates and maintains relationships with staff to encourage communication and enhance reporting of patient events.
• Provides crisis management support to staff to resolve patient or family issues and patient/family conflicts with staff.
• Acts as a resource expert to staff on professional/general liability issues.
• Provides risk management input into hospital policies and procedures.
• Maintains up-to-date knowledge and counsels’ staff on compliance with institutional policies and procedures, state and federal regulations governing patient care and the practice of medicine, and The Joint Commission standards relative to risk management issues.
• Promotes compliance with all applicable regulations including but not limited to the Joint Commission, Department of Health (DOH), Pennsylvania Patient Safety Authority, Safe Medical Devices Act (SMDA), Emergency Medical Treatment and Active Labor Act (EMTALA), and Health Insurance Portability and Accountability Act (HIPAA).
• Maintains up-to-date knowledge of the healthcare network organizational structure.
• Participates as a member on institutional peer review committees as indicated in the medical staff bylaws directed toward promoting patient safety issues.
• Participates in the review and consideration for billing disputes/concerns.
• Has rotating on-call responsibility.
• Maintains knowledge of national and local risk management trends and issues.
• Loss Prevention/Patient Safety
• Reviews and evaluates patient events and refers matters as appropriate to the Office of General Counsel.
• Works collaboratively with the Patient Safety Officer and the Office of Patient Safety and Quality on the review and investigation of patient events to promote patient safety and enhance the quality of care.
• Participates in the process of disclosure of serious or sentinel patient events.
• Participates in root cause analysis as deemed necessary.
• Develops risk management educational programs targeted to specific employee groups.
• Provides in-service training to healthcare system personnel to enhance their awareness of their role in reducing liability exposures.
• Provide oversight of the Hospital’s Patient Safety electronic event reporting system assuring appropriate event reporting.
• Responsible for submitting applicable incident reports, serious events, and infrastructure failures to the Pennsylvania Patient Safety Authority and Pennsylvania Department of Health.
• Collects and maintains data on occurrences to enable identification of trends, and recommends corrective action, as appropriate.
• Manages the process of reviewing all new medical devices/products requested through the CHOPtimize program to ensure that the organization is in compliance and that all risk in considered before purchasing and inserting the device/product into hospital operations.
• Claims Management
• Acts under the direction, supervision and control of the Office of General Counsel in investigating claims and patient events that could lead to financial loss to the institution, including gathering of medical records and other documentation, the interviewing of staff, and the analyzing/ interpreting of the information gathered through the investigation process.
• Provides paralegal support in ongoing litigation/claims against the institution and its staff including responding to pleadings and discovery, maintaining in-house litigation files and databases, interfacing with external defense counsel, supporting defendant care providers, participating in litigation strategy development including evaluation and appropriateness of settlement, and attending trial or alternative dispute resolutions such as; arbitration or mediation when appropriate.
• Serves as signatory for all verifications served on behalf of the Children’s Hospital of Philadelphia.
• Supports the Institutional Insurance Program
• Maintains general knowledge of the institution’s professional and general liability insurance structure.
• Coordinates departmental process for insurance carrier notification.
• Assures and clarifies insurance coverage status of individuals involved in patient events as part of the investigation.
• Facilitates claims history/insurance verification requests from all providers.
• Participates in setting loss reserves for professional liability claims.
• Participates as directed in activities associated with coverage renewals including claims audits.
• Provides primary professional liability coverage and claims histories for all CHOP insured providers.

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