Risk Mgr

Overview

Senior Risk Manager Ambulatory

Des Moines, IA OR within 5 hours

Full Time Benefits

The Senior Risk Manager will create an atmosphere that supports and encourages high performance, teamwork and continued dedication toward improved Risk Management throughout UPH. Serves as a resource, liaison and representative of UPC, expanding the capabilities of clinicians, managers, and administrators by providing them with resources to accomplish specific objectives aimed at decreasing risk across the health system, improving patient care processes and protecting the assets of the organization.

Why UnityPoint Health?

• Commitment to our Team

• For the third consecutive year, we're proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare for our commitment to our team members.

• Culture

• At UnityPoint Health, you matter. Come for a fulfilling career and experience a culture guided by uncompromising values and unwavering belief in doing what's right for the people we serve.

• Benefits

• Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you're in.

• Diversity, Equity and Inclusion Commitment

• We're committed to ensuring you have a voice that is heard regardless of role, race, gender, religion, or sexual orientation.

• Development

• We believe equipping you with support and development opportunities is an essential part of delivering a

• remarkable employment experience.

• Community Involvement

• Be an essential part of our core purpose-to improve the health of the people and communities we serve.

Visit https://dayinthelife.unitypoint.org/ to hear more from our team members about why UnityPoint Health is a great place to work.

Responsibilities

Risk Management

• Assist in the development, implementation, and maintenance of structures and processes which support risk management and patient safety.

• Work with Risk Managers/Analysts and be able to Perform their Duties as needed.

• Facilitate the collection, storage, and analysis of loss control, improvement, and safety data.

• Identify key performance indicators (KPIs) and key risk indicators (KRIs) for data collection, analysis and monitoring of activities to demonstrate reduction in risk and claims for UPC.

• Report on KPIs, KRIs and other loss control/claims data on a regular basis

• Investigate and develop risk reduction/loss control strategies from claims data.

• Responsible for the oversight and support of commercial obstetrics medical malpractice policy and insureds, including education plan/risk mitigation in clinic/outpatient sites.

• Develop policies, procedures, systems and works flows that enhance the overall Risk Management Program in UPC and throughout UPH Health System as appropriate.

• Initiate planning and development of risk management and loss prevention education for all departments & care providers.

• Establish and maintain communication between Risk Management and key areas throughout the Market/Affiliate and UPH Health System.

• Assist the Chief Medical Officer with development, implementation and monitoring of provider/clinical risk mitigation strategies including system-wide opioid stewardship, obstetrics services and other risk management initiatives.

• Utilize all available data sources, identify enterprise-wide loss drivers and develops systems, processes, and practices to improve patient safety and limit liability exposure.

• Provide risk management consultation and advice to executives, physicians, care providers and employees and maintains knowledge of current healthcare-related risk management trends and issues.

• Coordinate and/or conduct annual Risk Assessments in high-risk areas or process and implements actions plans from findings.

• Collaborate with UPH Legal, the Third-Party Administrator, commercial insurance carriers and defense counsel in supporting the litigation process.

• Serve as primary contact for claims/litigation management, acquisition of medical malpractice insurance and coordination of self-insurance for providers. Act as internal resource for inquiries related to medical malpractice claims and claims management.

• Proactively identify and assess liability risks of acquisitions/integrations and new providers/services.

• Respond to risk management inquiries from management, providers, and staff members including subpoenas, court orders, attorney and professional licensure inquiries, patient incidents, and other related requests.

• Complete and report potential liability issues and claims internally as well as to UPH, the Third-Party Administrator, and any other commercial insurers as indicated using claim reporting guidelines established by UPH legal and any commercial insurer as directed.

• Collaborate with claimants, legal, senior leadership and other colleagues to evaluate and when indicated, negotiate asserted claims to resolution.

• Coach, mentor, and develop risk management staff, and assists in the development and maintenance of the risk management department's budget.

• Serve as member of Critical Events Committee (CEC), safety, mortality/morbidity, and other committees that would benefit from risk management representation.

• Establish and maintain a data gathering and profile analysis for UPC-wide risk management activities:

o Review Event Reports to screen for potential liability and appropriate follow-up.

o Provide documentation on Event Reports which require follow-up/action for Risk Management.

o Work with departments to ensure timely follow-up of Event Reports

• Assist senior leaders, Directors, Managers, and other staff in using the Event Reporting computer system and serve as an RL Datix "admin lite." Investigate matters as designated by CEC and/or Risk Management based on severity of event and potential for compensation and/or litigation.

• For any Serious Safety Events and Sentinel Events, lead or contribute to investigation of event (to include staff interviews, review of records for timeline development, verification of policy/procedure compliance or variance). Collaborate with QI Coordinators to organize Root Cause Analysis.

• Complete medical record reviews, compare current practice against best practice guidelines and provide recommendations to reduce risk and improve patient care processes.

• Serve as the administrative lead of the UPC Clinical Peer Review Committee and coordinate peer review cases.

• Lead/Organize disclosure teams for adverse outcomes when appropriate for disclosure.

• Collate, write and disseminate quarterly Risk Analysis and Summary report.

• Support Patient Relations with Complaint and Grievance responses specific to harm (and potential for liability).

• Investigate potential compensable events as directed by Director or UPH Legal, which may include interviews of medical staff, employees, visitors, and patients, and assesses potential liability.

• Identify potential loss conditions and practices and evaluates their significance. Report findings and devise remedial action plans.

• Develop and implement loss prevention educational programs and materials.

• Draft or review documents to reduce institutional exposure to liability.

• Perform other duties as required or assigned.

Basic UPH Performance Criteria

• Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.

• Demonstrates ability to meet business needs of department with regular, reliable attendance.

• Employee maintains current licenses and/or certifications required for the position.

• Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.

• Completes all annual education and competency requirements within the calendar year.

• Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

Qualifications

Education

Bachelor's degree in nursing, health-related field or risk management.

Experience

Five years previous risk management experience required

Experience applying modern improvement methodology to lead change required.

Experience in the concepts and applications of continuous improvement including ability to manipulate data, trend and analyze data

License(s)/Certification(s)

Valid driver's license when driving any vehicle for work-related reasons.

Certified Professional in Healthcare Risk Management (CPHRM), Associate in Risk Management (ARM), or Certified Professional in Patient Safety (CPPS).

Knowledge/Skills/Abilities

• Writes, reads, comprehends and speaks fluent English.

• Demonstrated excellence in judgment, temperament, confidentiality, collaboration, education, written and verbal communication skills, facilitation, and crisis management teaching and interpersonal skills.

• Must be familiar with general clinical aspects of patient care.

• Flexibility, tolerance, and demonstrated ability to prioritize multiple tasks with attention to detail essential.

• Demonstrated ability to interact with a wide diversity of people and situations while maintaining a customer focus.

• Ability to adapt to stressful situations quickly and effectively.

• Must have accurate word processing/computer skills.

• Must have excellent verbal/written communication skills, analytical skills, and must exhibit good judgement.

• Must have knowledge and good understanding of hospital policies and procedures related to patient care and safety

• Proficient use of software applications including but not limited to Microsoft Word, PowerPoint, Excel and Outlook

Other

Use of usual and customary equipment used to perform essential functions of the position.

• Area of Interest: Management;

• FTE/Hours per pay period: 1.0;

• Department: Risk Management;

• Shift: Monday-Friday 8:00AM-5:00PM;

• Job ID: 150788;