Risk Manager I

POSITION DESCRIPTION:

Responsible for leadership of IHA’s risk management activities in both the inpatient and outpatient settings, which includes, but may not be limited to:  Daily support for IHA’s risk management program by serving as a clinical resource for risk prevention, enhancing quality care, confirming insurance coverage, monitoring claims and minimizing loss exposures to protect the assets of the facility. 

Responsible for identifying, assessing and recommending corrections for all areas of risk in an effective manner.  Assures adherence to all government regulations and accrediting body standards, organizes and implements policies and procedures necessary to support risk structures and processes; this position serves as a point of contact for risk management concerns, both new and ongoing.

The position is responsible for identifying internal health system quality and safety issues and analyzing the root causes and underlying factors. This Manager promotes the organizational patient safety initiatives and works with other Directors, Managers, Supervisors and medical staff leadership to develop process changes and improvements; serves as a point of contact for IHA claims with IRMS and works to develop risk mitigation strategies and education.

ESSENTIAL JOB FUNCTIONS:

1. Collaborates with Provider Credentialing in completing and evaluating provider malpractice insurance insurability.
2. Collaborates with the Patient Relations Specialist; assists with medical record reviews and facilitating discussions to help resolve patient complaints and grievances.
3. Develops, coordinates, and administers facility-wide systems for risk identification, investigation and reduction; performs risk surveys to assess loss potential.  Performs routine audits of and monitors risk functions.
4. Collects, evaluates and distributes relevant data concerning patient events.  Performs proactive analysis of patient safety and medical errors and processes. Participates in root cause analysis and learning from defects.  Provides aggregate date analysis of risk data; maintains statistical trending of losses and other risk management data.  Follows up on action items and tasks assigned in safety learning events. 
5. Reviews policies, processes to formulate potential for organizational changes, and makes recommendations for approval by senior leadership.  Informs directors of service and department heads regarding occurrences, issues, findings and risk management suggestions; provides feedback to directors to eliminate risks; assists the Director of Compliance and Risk Management and Dept. Chairs in designing risk management strategies. 
6. Participates on committees directed toward promoting patient safety and risk management work. Serves as IHA liaison for all risk-related legal matters. Prepares files and agenda for IHA’s Risk Management Committee. Attends and participates in Trinity Health Risk committee activities as requested. 
7. Monitors and manages legal case files; ensures all active risk management cases are properly logged and kept current; responds to requests for claim information; works with IHA Physicians and Managers to gather information; responds to request to gather employment dates for insurance verification purposes. 
8. Works with legal counsel and or other IRMS associates to coordinate the investigation, processing and defense of claims against IHA.  Records, collects, documents, and maintains information needed by IHA in the defense of our claims or submit for claim reimbursement. 
9. Maintains risk management statistics and ensures that claims files that are up to date and in compliance with state and federal agencies.
10. Promotes accurate and complete medical record integrity.  Directs and coordinates release of records and information in response to subpoenas, court orders, attorney requests, state and federal agency investigations and other inquiries on records legal questions and depositions.
11. Receives, develops and communicates appropriate responses to risk events and medical care complaints with appropriate physician peer review.  Works to resolve complaints in a fair and professional manner.
12. Serves as a point of contact for IHA risk management concerns, both new and ongoing; provides guidance for IHA Providers and Practice Managers on risk-related issues; Responds appropriately to risk-related questions.
13. Recommends appropriate revisions to new or existing policies and procedures to reduce the frequency of future occurrences.  Develops and implements risk prevention strategies through system changes; works through the IHA Risk Management Committee to identify areas where policy development will benefit IHA’s overall risk plan.
14. Manages electronic information database for investigative activity; utilizes data from trend analysis for the identification of opportunities to strengthen internal processes and minimize risk areas.
15. Advises Senior Management and IHA Risk Management Committee regarding the development and implementation of risk strategy, potential areas of concern and new regulations or developments.
16. Manages improvement activities related to issues that are connected to event reports, peer review, root cause analysis and other patient safety concerns, including serving as a resource for risk-related questions for Joint Commission activity.
17. Manages the development and implementation of a relevant and comprehensive risk education curriculum in collaboration with IHA’s Learning and Development Department where appropriate.  Partners with IHA Human Resources to support coaching opportunities.
18. Serves as administrative support to the IHA Risk Management Committee; develops meeting agenda, prepares reports/PowerPoint slides, summaries and packets; maintains meeting notes and delegates and ensures meeting minutes are complete and ready for distribution.
19. Oversees and ensures that the enterprise-wide risk assessment is performed for IHA on at least an annual basis, in collaboration with Compliance team.  Proactive analysis of patient safety and facility safety. 
20. Maintains knowledge and complies with applicable healthcare laws, regulations and standards concerning patient care.  Maintains awareness of legislative activities that may affect risk management programs.
21. Supports other offices, attends meetings and training as assigned.
22. Performs other duties as assigned.

ORGANIZATIONAL EXPECTATIONS:

1. Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the IHA CARES mission and core values statement.
2. Must be able to work effectively as a member of the Risk Management team.
3. Successfully completes IHA’s “The Customer” training and adheres to IHA’s standard of promptly providing a high level of service and respect to internal or external customers.
4. Maintains knowledge of and complies with IHA standards, policies and procedures, including IHA’s Employee Handbook.
5. Maintains knowledge of IHA office services and in the use of all relevant office equipment, computer and manual systems.
6. Maintains strict patient and employee confidentiality in compliance with IHA and HIPAA guidelines.
7. Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities.  Embraces new ideas and respects cultural differences.
8. Uses resources efficiently.
9. If applicable, responsible for ongoing professional development – maintains appropriate licensure/certification and continuing education credentials, participates in available learning opportunities.

MEASURED BY:

Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.

ESSENTIAL QUALIFICATIONS:

EDUCATION:  Bachelor’s Degree or equivalent combination of education and experience.

CREDENTIALS/LICENSURE: Registered Nurse with current State of Michigan licensure, preferred; Certified Professional in Healthcare Risk Management (CPHRM) or FASHRM, preferred.

MINIMUM EXPERIENCE:   4 or more years’ experience in the following areas, preferred: HIPAA, healthcare risk management, regulatory standards, patient safety, prior clinical experience, or other relevant area.

POSITION REQUIREMENTS (ABILITIES & SKILLS):
 

1. Well-developed understanding and/or hands on experience with office processes, procedures and workflows.
2. Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, Microsoft Word and Excel, intranet and computer navigation.  Ability to use other software as required while performing the essential functions of the job including EPM and EHR systems.
3. Proficiency in planning, organizing and prioritizing workloads.
4. Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, providers, patients, family members, vendors and the general public.
5. Excellent communication skills in both written and verbal forms, including proper phone etiquette.  Ability to speak before groups of people, either in-person or virtually, and apply consultative skills to work effectively within assigned areas of the organization.
6. Ability to coordinate activities and work independently to complete projects requiring highly complex analysis.
7. Works collaboratively in a team-oriented environment; displays courteous, professional and friendly demeanor.
8. High level of organizational and time management skills with ability to effectively juggle multiple priorities and time constraints in a fast-paced environment.
9. Exercises sound judgment and problem-solving skills.
10. Ability to maintain any organizational information in a confidential manner.
11. Successful completion of IHA competency-based program within introductory and training period.
12. Ability to drive to other office/practice sites and meeting and training locations.
13. Ability to work overtime hours as scheduled.

 MINIMUM PHYSICAL EXPECTATIONS:

1. Physical activity that often requires keyboarding, filing and phone work.
2. Physical activity that often requires extensive time working on a computer and sitting.
3. Physical activity that sometimes requires walking, bending, stooping, reaching, and/or twisting.       
4. Physical activity that sometimes requires lifting, pushing and/or pulling under 30 lbs.
5. Specific vision abilities required include close vision, depth perception, peripheral vision and the ability to adjust and focus.
6. Manual dexterity enough to operate a keyboard, photocopier, telephone, calculator and other office equipment.
7. Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.

MINIMUM ENVIRONMENTAL EXPECTATIONS:

This job operates between working in a typical office environment which involves frequent interruptions and interaction with people which can be stressful at times.