Healthcare Risk Management Program Manager

Summary of Duties

Relocation Assistance available up to $15,000

Pay range: $104,000/yr - $157,060.80/yr

 

The Risk Management Program Manager is responsible for organizational administrative and clinical risk management activities which include, but may not be limited to identifying, examining and responding to risk-related issues and complaints involving Hillsboro Medical Center (HMC) facilities, employees and medical staff, managing or assisting in quality- and risk-related investigations to promote safe patient care, staff safety and identifying, managing and mitigating potential liability. The RMP Manager Collaborating and consulting on complaints/concerns identified by the Patient Advocate that have risk management implications; monitoring organizational event reporting with primary focus on incidents involving harm or potential liability and working with Quality/Patient Safety on trending to identify opportunities for improvement; managing and analyzing risk management information (data); proposing, recommending and implementing solutions and resolutions to risk-related issues and events; following up on the implementation and impact of proposed solutions and resolutions. Contributes to a positive work environment that promotes HMC values.

 

Identification and Investigation of Risk-Related Events. Representative duties and responsibilities include, but are not limited to:

• Reviews events and complaints that pose organizational risk requiring attention and investigation and develops appropriate responses in conjunction with Director of Quality, Patient Advocate, and Patient Safety Program Manager. Informs executives of involved areas of risk findings.
• Participates in quality and patient safety event review meetings to discuss agenda items and conduct necessary follow-up.
• Initiates investigation of potentially compensable events (PCEs).
• Collaborates with CMO and Quality Department regarding peer review matters with risk-related implications.
• Proactively implements necessary processes to identify and evaluate risks to employees and patients, implementing necessary risk controls to mitigate identified risks. These activities should be embedded into a systematic risk management process and review and consistent with Regulatory and certification agency requirements.

Monitoring of Activities that Increase Patient Care Risks or Legal Action. Representative duties and responsibilities include, but are not limited to:

• Analyzes event reporting data and makes recommendations for future review/ action.
• Participates in activities designed to reduce risk exposure and improve quality and safety of patient care (e.g., Root Cause Analysis (RCA), Failure Modes Effects Analysis (FMEA), Patient Safety Organizations (PSOs) and quality improvement teams.).
• Facilitates Risk Assessments as needed to proactively identify, evaluate and mitigate areas of risk.
• Acts as a liaison and resource to staff to assess risk exposures in specific clinical and other situations (e.g., Facilities, Safety, Nursing, Pharmacy, Security and Patient relations).
• Works with quality/safety, biomed/engineering and clinical operations to identify medical device and equipment failures for purposes of improving organizational risk, patient safety and for required agency reporting, such as the FDA.
• Participate as member of various organizational councils / committees to provide risk management perspective and input for purposes of managing organizational risk and promoting patient safety activities.

 

Claims Management Processes and Data Management. Representative duties and responsibilities include, but are not limited to:

• Acts as liaison and main point of contact for organizational insurance programs and resources and managing claims against the organization’s insurance program; interfacing with general counsel and defense counsel, Mountain States Hospital Risk Retention Group (MSHRRRG) risk managers, and insurance company claims representatives.
• Actively participates in MSHRRRG quarterly meetings, ASHRM education opportunities and other available resources to identify, share, and implement best practices.
• Conducts investigations and analysis of potential and actual property, auto, cyber, general and professional liability claims filed against the HMC (facilities, employees, medical staff) in conjunction with HMC General Counsel and OHSU contracted resources.
• Utilizes clinical expertise to review related clinical information (e.g., medical record, relevant medical literature); conduct investigatory interviews with individuals involved, named parties, and/or other clinical experts.
• Coordinates with General Counsel, MSHRRRG, and retained counsel all aspects of claims process which includes but is not limited to: coordination of depositions; response to interrogatories; requests for production of evidence; insuring documentation and data management.
• Coordinates with insurance company claim representatives and internal and external legal counsel to successfully manage, mitigate, and resolve claims.
• Oversees collection and dissemination of confidential claims information and data to authorized individuals and institutions for purposes of credentialing, reappointment and other purposes (e.g. clarifying coverage and providing claims information for faculty, Graduate Medical Education trainees, Advance Practice Providers and other staff) in coordination with Medical Staff Office and HMC General Counsel.
• Oversees and reviews periodic risk management claim reports as needed (e.g., loss runs).
• Coordinates the timely and accurate response to inquiries for claims history and coverage information

 

Develops, Coordinates and Provides Risk Management Training and Educational Programs. Representative duties and responsibilities include, but are not limited to:

• Collaborates with various HMC departments to analyze data (e.g., complaints, grievances, claims, lawsuits) to identify priority topics and audiences for targeted training and education.
• Utilizes external data (local, state, national) to identify high-risk topic areas and focus groups for targeted education.
• Collaborates with clinical education to offer risk educational programming on a regular basis and per request to a variety of audiences
• Coordinates and collaborates with OHSU risk management department. Assists with various risk management activities as requested (e.g., claims management, educational activities, committee participation)
• Participates in HMC’s Compliance Program to provide input into policies and procedures. Participates in compliance reviews and investigations as requested or directed. Acts as a member of the compliance committee.
• Active participation with American Society for Healthcare Risk Management (ASHRM), registered agent for the Oregon patient safety commission as the contact for the Early Discussion and Resolution (EDR) program, and actively participates with our Patient Safety Organization (Vizient).

 

Organizational Duties & Responsibilities

 

Supports and represents Hillsboro Medical Center’s mission, vision, and values.

• Compassion: Creates a welcoming environment of kindness, inclusivity, and responsiveness
• Collaboration: Works with others to improve the health and wellness of Hillsboro & Washington County
• Excellence: Provides the highest quality of care and service
• Integrity: Demonstrates honesty, transparency, and accountability in every task and every interaction

Hiring Competencies

Education & Experience

 

Required: 

• Bachelor’s degree in nursing education; and
• Five (5) or more years of progressive experience in a healthcare setting or with a provider of services to the healthcare industry.
• Three (3) years’ experience in healthcare risk management in a healthcare setting or with a provider of services (e.g. consultant, broker, or attorney) to the healthcare industry.
• Certified Professional in Health Care Risk Management (CPHRM) certification or willingness to acquire within 9 months of hire.
• Active member of American Society For Healthcare Risk Management (ASHRM). Organization to support membership fees upon hire and annually. 

Required Knowledge, Skills, and Abilities

 

Knowledge of:

• Healthcare regulations and accreditation standards.
• Clinical practice in hospital or surgical setting.
• Medical/legal process, professional liability insurance, claims administration and insurance program management in healthcare.

Skill in:

• Professional and effective written and verbal communications.
• Root cause analysis.
• Attention to detail.
• Professional-level data management, documentation, and reporting. 

Ability to:

• Learn, develop/maintain proficiency, and effectively use current technology, equipment, and software programs, including electronic medical records, Microsoft Office suite (Outlook, Word, Excel, and PowerPoint), and other systems and equipment.  
• Work independently performing a wide variety of assignments that require the use of independent judgment, critical analysis, systems-thinking, problem-solving, organization, and prioritization skills. 
• Identify potential barriers to communication and employ communication strategies appropriate to the audience/situation.
• Maintain composure and professionalism in sensitive or stressful situations.
• Cultivate effective interpersonal relationships and work in collaboration with internal and external stakeholders.
• Work on site and attend in-person meetings on a regular basis.

#Tier3

Additional Posting Information

Hillsboro Medical Center believes in providing equal employment opportunities for all qualified individuals. Recruitment, hiring, promotions, transfers, working conditions, training, and compensation will be based on qualifications without regard to race, color, sex, sexual orientation, gender identity, religion, age, creed, national origin, marital status, family relationship, veteran status, genetic information, physical or mental disability, or any other status or characteristic protected by applicable law. We further commit ourselves to continuing the practical application of this policy in our daily business conduct.

Salary : $104,000 - $157,061