At Independence Physician Management (IPM a subsidiary of UHS Inc.) we are looking for exceptional people who share our vision and values, who share our focus on hard work, enthusiasm, teamwork, loyalty, trust and cooperation. We've embraced these traits and built a team of employees who consistently work to achieve the highest level of service excellence.
People are our most valuable resource at IPM as we are committed to providing high quality acute care and behavioral health services to residents of the communities we serve. We are equally committed to offering our employees unlimited opportunity in an environment that encourages professional development.
Oversees the effective development, implementation, and evaluation of Independence Physician Management ("IPM")-wide Risk Management Program under the direction of Corporate Risk Management leadership. Assesses for compliance of regulatory requirements, disseminates information on new regulatory requirements, coordinates and oversees implementation of changes to policy/practice related to meeting requirements, including contract review, and acts as the IPM contact with regulatory agencies.
Manages the submission of professional and general liability claims of all IPM practices under the direction of IPM leadership, and Corporate Risk and Claims Management leadership, including the coordination of depositions and gathering of the necessary information. Coordinates the review and investigation of risk related events, and keeps senior leaders apprised of such cases through appropriate reporting to senior leadership and corporate leadership as it relates to risk management. Routinely assesses and updates patient consent forms, patient discharge processes, clinical staff competency parameters and provider performance from a risk perspective.
Conduct risk assessments and oversee the implementation of recommended improvements in the practices. Collects and analyzes data related to patient occurrences and makes recommendations for implementation in regard to patient safety and risk reduction. Performs investigations and follow-up activities related to specific issues identified in occurrence reporting and claims.
Recommends and implements programs to mitigate risk. Provides education to staff; physicians and Board Members on risk related programs. Utilizes technical skills (i.e., fish bone diagram, pareto charts) to facilitate the Root Cause Analysis (RCA) process for near miss and sentinel events within 30 days of the occurrence.
This role will also provide ethics and regulatory compliance support for a large medical group and its physician practices. This role is responsible for (1) overseeing the medical group's compliance program, which includes establishing and updating compliance policies and processes, (2) establishing and chairing the IPM Compliance Committee. Coordinating with UHS Office of General Counsel, for legal support as necessary and providing regular and periodic reports to the UHS Chief Compliance & Privacy Officer on IPM's Compliance Program, (3) conducting trainings, audits, and investigations when appropriate and/or in response to compliance hotline complaints, (4) implementing and overseeing controls around patient information access, physician compensation and other elements of the compliance program; and (5) providing compliance and privacy support to the medical group as otherwise needed.
Coordinates and administers risk identification, investigation and reduction, monitors risk functions and performs risk assessments/surveys to assess loss potential. Ensures action plans are done and follow-up completed. Audit physician compensation to ensure compliance with regulatory and company guidelines.
Performs investigation and response to events, potential claims, and grievances presented against caregivers, physicians and the organization for liability and damages.
Records and collects documents and evidence, including preservation in accordance with legal requirements and sets up claim, including ensuring proper reporting to the organization insurance coverage of potentially compensable claims, suits, letters of rep. against liability and casualty loss.
Collaborates with CMO and quality to ensure timely risk management review and management of serious patient events and medical errors.
Facilitates the review of adverse events and directs the communication of unanticipated events to patients and potential compensable events. Provides clinical risk management guidance including disclosure of unanticipated events.
Participates in development of processes/systems designed to share and recognize performance improvements and compliance across the organization to mitigate risks to patient and caregiver safety/risks to the organization, including a risk management manual for Physician office practices.
Develop, implement and oversee IPM-wide Compliance Program including audit of physician compensation to ensure compliance with regulatory and company guidelines, audit payments to physicians to ensure accuracy and compliance with contract terms,
provide training on compliance matters. Prepare regular and periodic reports to UHS Chief Compliance Officer with updates on all aspects of the IPM Compliance Program.
Chair IPM Compliance Committee and assume associated tasks of convening meetings and reporting on healthcare compliance and privacy issues.
Provide guidance to IPM on access to and disclosure of patient information, data security requirements, and addressing data breaches.
Review and negotiate Business Associate Agreements.
Serve as main point of contact for state licensing boards making inquiries of IPM-physicians and handle similar requests.
Serves as a liaison and problem solver to provide guidance for enterprise risk prevention for new clinical services, programs and equipment.
Performs other duties as assigned
Education: BA/BS degree.
Minimum three- five years of healthcare risk management experience, including compliance experience. Physician office practice RM experience preferred.
Equipment, Applications and Tools: Superior computer skills and oral/written communication skills are necessary. Must be organized, able to work with all levels of people and have an understanding of the end result.
Work experience: Candidate should have an understanding of fraud and abuse laws, security and privacy laws, billing and coding requirements, physician compensation and CPT codes and wRVUs. Strong risk management knowledge, including ability to interpret policy and basic foundation of litigation.
25% Travel Required.
If you meet the above requirements and are looking for a rewarding career, please take a moment to share your background with us by applying online. Independence Physician Management offers competitive compensation commensurate with experience and benefit programs including medical, dental, life insurance, and 401(k).
Independence Physician Management is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails.
All resumes submitted by search firms to any employee at IPM via email, the Internet or in any form and/or method without a valid written search agreement in place for this position will be deemed the sole property of Independence Physician Management. No fee will be paid in the event the candidate is hired as a result of the referral or through other means.
Universal Health Services