What are the responsibilities and job description for the Manager, Risk Management and Accreditation - Ukiah Valley position at Adventist Health?
Adventist Health Ukiah Valley has been deeply connected to the community we serve since 1956. We are comprised of a 50-bed acute care medical center, level IV trauma center, level II intensive care nursery services, extensive physical rehabilitation program, outpatient surgery and diagnostic center and advanced wound care center. Ukiah is a unique small town that charms you with its rich character, arts, vineyards and natural surroundings. Ukiah beckons you to explore all that the valley has to offer amidst our 300 days of sunshine each year. We are also conveniently located just two hours north of San Francisco and 45 minutes from the Pacific Coast.
Job Summary:
Manages and oversees the risk and accreditation programs of the organization. Oversees risk management activities including processing claims filed against the facility, interfacing with defense legal counsel, administering education programs and complying with risk management related regulations set by the regulatory and accreditation agencies which these facilities are responsible to adhere to. Oversees accreditation and regulatory compliance by having knowledge of the regulations of CMS, State, The Joint Commission (accreditation organization) and others applicable. Keeps updated with regulatory changes and provides education to the facilities of these changes and impact to the facilities. Ensures survey readiness, manages and assists with surveys, and participates in the development of plans of corrections and sustainability plans. Develops and implements appropriate measures to identify/minimize the risk of injury to patients, visitors and staff, and to minimize loss/damage to property. Responds to all patients/visitors complaints/concerns that cannot be dealt with at the unit level. Supervises/directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment. Leads with objective of enhancing/promoting patient safety, ensuring quality care and minimizing loss to protect the assets of the organization.
Job Requirements:
Education and Work Experience:
- Bachelor’s Degree or equivalent combination of education/related experience: Required
- Master's Degree: Preferred
- Five years' technical experience: Preferred
- Five years' leadership experience: Preferred
Licenses/Certifications:
- Current RN license in state of practice: Required
Essential Functions:
- Coordinates organization's readiness rounds program and maintains responsibility for the development, communication, implementation and tracking of action plans necessary to close identified gaps in care/compliance. Checks regulatory websites for new information and is instrumental in developing assessments and achieving organization readiness. Educates the organization on regulatory and accreditation issues and follows up on Sentinel Event Alerts. Tracks, reports and ensures the completion of action items resulting from compliance reviews. Analyzes and investigates serious safety events in support of the patient safety program.
- Creates reports after review of unusual occurrence and adverse events, and alerts appropriate regulatory body. Develops and implements appropriate measures to identify/minimize risk of injury to patients, visitors and staff, and to minimize loss or damage to property. Receives incident reports and other information regarding untoward occurrences in the facility, such as assurance outliers or variations. Collates information systematically to permit analysis pursuant to risk management policy/procedures.
- Maintains responsibility for implementing, coordinating and monitoring risk management programs including risk detection, assessment and prevention. Facilitates analysis teams and proactive risk assessments. Develops, maintains and updates policies/procedures relating to risk management, patient safety and customer service claims staff.
- Risk Management / Liability Claims Liaison: Acts as Site Administrator for HRP Claims Module (Potentially Compensable Event) and maintains legal case files. Investigates and reports potentially compensable events (PCEs) and asserted claims (demands for compensation, services or litigation) to the Trust pursuant to the corporate policy for reporting to the Trust. Provides investigation findings/information to claims staff including identity of location/site/clinic involved, identity (full name, job title) of involved parties, witnesses (how they are/were involved) etc., narrative description of the events, issues identified and recommendations for additional investigation. Investigates and responds (in writing) to requests from patients/visitors for compensation or payment for services, e.g., physical therapy, home health, specialist consultation, etc. Serves as primary contact for defense counsel and corporate claims staff.
- Facilitates/verifies discovery and requests for documents, information, interviews and depositions. Obtains concurrence for settlement, trial, etc. Works with legal counsel to coordinate investigations, process and defend claims against the facility. Obtains/maintains records and documents and provides them to defense attorneys for preparation of testimony in pending litigation. Safeguards materials obtained or developed for root cause analysis to ensure documents/proceedings are protected from discovery. Initiates and monitors efforts to preserve evidence, i.e., surveillance video, equipment memory, etc., and/or litigation holds. Attends trial as site representative, coordinates litigation activities involving site interviews, depositions, witness preparation, etc. Approves payment for replacement of lost property after claim evaluation. Negotiates settlement of small claims within administrative authority and advises collection department of appropriate action for unpaid accounts involved in litigation.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.
