Risk Management Specialist

Job Summary:

The Risk Management Specialist is responsible for risk management activities related to patient safety and quality of care., Activities include assisting with the coordination of insurance coverage and risk financing; monitoring claims against the facility; interfacing with defense counsel; administering the risk management program on a day-to-day basis; managing, analyzing, and reporting risk management data; conducting risk management educational programs; assisting in quality review; and complying with applicable laws and accreditation standards. These activities are carried out with the dual objectives of controlling and minimizing loss to protect the assets of the facility and providing safe patient care.

Duties/Responsibilities:

• Responsible for proactive risk reduction, oversight/trending of event reports, and knowledge of applicable state and federal regulations.
• Monitor, analyze, and trend risks identified throughout the organization in the event reporting system.
• Appropriately and timely manage reported safety events through review, investigation/follow-up, coding, development of action items to address and closing of events in the online event reporting system.
• Routinely and proactively identify risks through review of medical staff peer review issues, patient/family grievances, committee minutes, third party reports, attorney requests for medical records, and administrative or associate referrals.
• Identify adverse events and complete timely thorough investigation and follow-up which may include participation in Clinical Outcomes Reviews and/or Root Cause Analysis (RCA’s) and debrief as indicated.
• Ensure timely reporting of adverse events to appropriate regulatory agencies as required by state and federal laws.
• Oversee the management of formal grievances in a manner that expresses care and concern for those who were provided services that did not meet their expectations.
• Complete the grievance process to meet state and federal regulations.
• Present risk data at identified committees and meetings to facilitate transparency and collaboration in addressing identified risk trends.
• Participate in established hospital quality and patient safety oversight committees.
• Collaborate to develop innovative approaches intended to reduce the frequency and severity of medical malpractice, patient injury, and other claims.
• Assist the Director of Risk and Compliance with the management of claims, which may include the following activities:
  • Reporting procedures.

  • System maintenance

  • Detailed claim investigations

  • Selection and monitoring of legal counsel, as indicated.

  • Direct consultation with claimants, attorneys, physicians, employees, brokers, consultants, and carriers.

  • Settlement of claims.

  • Selection and utilization of actuarial firms, as needed and/or required.

  • Compliance with Medicare/Medicaid Federal and State Regulations.

  • Recommending to senior management appropriate funding requirements and necessary limits of coverage

  • Reporting claims information to senior management and the board.
• Participates in select committees related to the improvement of patient care and organizational safety and security (e.g., Safety/Disaster, Infection Control, Pharmacy and Therapeutics, Utilization Review, Quality etc.)

Required Skills/Abilities:

• Solid knowledge of Microsoft Office applications.
• Must have exemplary oral and written communication skills and be able to interact effectively with employees at all levels of the organization, member of the medical staff, and patients/families.
• Ability to investigate and analyze incidents, immediately access potentially liable situations, and react appropriately.

Education and Experience: