Director of Risk Management/Quality

Job Description

Job Description

DIRECTOR OF RISK MANAGEMENT / QUALITY

At HealthCore Clinic, we pride ourselves on being a premier medical employer and learning institution for individuals willing to serve the underinsured.    Our “You-Centered” approach to healthcare for our clients only works because we employ, train and retain the best of the best.

At Healthcore Clinic, we believe healthcare is a human right whose access should not be bound by finances.    If you believe in our philosophy and are fun loving, open minded, caring and flexible with your schedule, then you have come to the right place.    We are people serving people, serving people.    We are looking for a dynamic individual to join our family at Healthcore Clinic.

Summary : Manages the operation of the organization-wide risk management and patient safety programs and provides guidance to clinical staff. Coordinates risk management functions to maximally ensure that identification of risk exposure, assessment, appraisal, and loss prevention are carried out so that the institution remains safe for its patients, families, and employees. Identifies and limits legal exposures. Assists Executive officers in the handling and defense of legal claims. 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.  HealthCore Clinic’s key aims in this area is a proactive approach to improving health outcomes and service, increasing patient safety, and reducing error in healthcare processes.

Job Responsibilities :

• Evaluates all incidents for severity, frequency, and probability of financial loss, and reports as necessary to appropriate administration, committees, and personnel. Establishing the level of risk HealthCore is willing to take.
• Develops and maintains an incident reporting system by establishing a comprehensive incident reporting plan that establishes policies, educational programs, and reporting methods for the appropriate areas. Directs information on incidents as appropriate to medical and support staff and uses industry benchmarking to compare appropriate data.
• Directs the risk investigation of all identified potentially compensable events (patient, visitor, employee, and product).
• Develops loss control measures relating to patient care complaints.
• Develops and implements preventive risk management programs.
• Educates and trains staff in appropriate procedures, documentation, reporting, and follow-up in key areas of risk management interest, including patient relations, and customer relations topics.
• Collaborate with HR staff and other department specific staff to develop and provide training to employees in areas relating to risk management and other areas as needed, including administration of learning management system (LMS),
• Incorporates current regulatory guidelines and standards into program development.
• Acts as the facility’s resource in risk reduction and keeps abreast of trends in the industry.
• Demonstrates knowledge and implementation of creative and innovative risk management processes.
• Builds and maintains trusting relationships with both internal and external customers to enhance communication regarding risk and safety.
• 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.
• Acts as the Patient Advocate in analyzing patient complaints and conducts internal investigations including inquiries to appropriate personnel.
• Provides support to Executive staff in relation to outside litigation counsel in the management and investigation of filed lawsuits, professional liability claims and related litigation processes. Understands the legal components of the risk management industry.
• Reviews and revises the risk management plan and all risk management policies on an annual or biannual basis as required.
• Prepares and manages the risk management budget.
• Chairs Quality & Risk Management Committee and participates as a member of appropriate subcommittees and task forces assigned to improve quality and safety and to reduce organizational risk.
• Prepares all necessary documentation and promotes compliance with internal policies and external regulations regarding areas of risk management responsibility, including but not limited to sentinel events and root-cause analyses.
• Develops statistical and qualitative reports on risk management trends and patterns and communicates this information effectively to appropriate audiences.
• Promotes compliance with all applicable regulations. Assists teams with compliance and leadership regarding regulatory standards and requirements and facilitates compliance.
• Trains and supervises risk management staff.
• Serves as a resource to facility staff on issues related to risk management and patient safety. Demonstrates role model behavior regarding proper customer satisfaction, conduct, confidentiality, complaint resolution, and problem solving.
• Develops annual goals for the risk management department. Employs a vision to develop new concepts and solutions. Is inspired to succeed and driven to deliver on goals and expectations.
• Ascertains that risks are minimized through follow-up and actions on all regulatory / insurance survey report recommendations / deficiencies. Understands the fiduciary duties to identify, disclose, and manage the organization’s risk.
• Perform risk assessments, analyzing current risks and identifying potential risks that are affecting the company.
• Proactively recommends appropriate revisions to new or existing policies and procedures to eliminate or reduce risk and to prevent future occurrences.
• Conduct policy and compliance audits, which will include liaising with internal and external auditors.
• Schedules, facilitates as needed, and coordinates preparation for risk management root-cause analyses (RCAs), tabletop discussions, etc. Collaborates to develop and monitors required follow-up actions items.
• Coordinates with designated personnel to handle medical records requests, subpoenas, requests for depositions and expert testimony from the courts, attorneys, and other institutions.
• Prepares reports from the risk information management (RIMS) and communicates suggested improvements to stakeholders and appropriate departments. Provides performance improvement recommendations from analysis of trended data.

Problem Solving

Directs the risk investigation of all potentially compensable events (patient, visitor, employee, and product) reported to the risk management office. Regularly required to diplomatically deal with patients, visitors, and employees when a potentially compensable event has occurred. Keeps executive staff informed of case progress. Maintains contact with providers and clinicians regarding risk issues. Informs appropriate individuals of significant cases. Works with providers and clinicians to control risk. Possesses ability to listen and to manage conflicts and achieve compromise.

Decision Making

Determines loss control measures relating to patient care complaints and potentially compensable events when there is a risk issue including, but not limited to, access to medical care and the provision of certain treatments when appropriate. Determines the most appropriate course of action regarding lost and stolen belongings. Recognizes and analyzes problems. Possesses ability to make difficult choices under uncertain conditions. Shows good judgment.

Work Relationships

Develops and maintains collaborative relationships to enhance program effectiveness and advises how to manage risks. Can build trust while maintaining confidentiality. Has a high emotional intelligence. Acts as effective team leader and motivator.

Other Job Duties

Qualifications

Education / Experience

Bachelor’s Degree in business, healthcare or risk management, public administration, quality management, nursing or related field preferred.  Successful experience in healthcare risk management and / or continuous quality improvement preferred. Certification in healthcare risk management required.  Experience with eClinicalWorks a plus.

HealthCore Clinic offers competitive salaries with benefits for positions in medical and non-medical fields. Not only is HealthCore a renowned employer with excellent employee satisfaction ratings, but we are also innovators in the field of community health services. Some of the benefits we offer include :

Medical Health Insurance

Dental Insurance

Healthcare FSA

Vision Insurance (HCC paid for employee only)

Voluntary Life Insurance (HCC paid)

STD and LTD (HCC paid)

401K with HCC contribution

Tuition Reimbursement

Not only is Healthcore Clinic a great place to get care, it’s also a great place to work!