Risk MGT Specialist - St Peters Hospital

Employment Type:

Full time

Shift:

Day Shift

Description:

TITLE: Risk Management Specialist

DEPARTMENT: Risk Management

REPORTS TO: Regional Director Risk Management

MISSION STATEMENT: We, Trinity Health, serve together in the spirit of the Gospel, as a compassionate and transforming healing presence within our communities.

VISION: We will be the most trusted health partner for life.

CORE VALUES: Reverence, Commitment to Those Who are Poor, Safety, Justice, Stewardship, Integrity.

POSITION SUMMARY

The Risk Management Specialist is responsible for the implementation of the facility's non-clinical risk management activities in both the inpatient and outpatient settings for the TH NY Region (SJH and SPHP). The Risk Management Specialist is responsible for data management, claims management, and supporting the education components of the facility's non-clinical risk management program within the Risk Core Functions. Promotes the organizational patient safety initiatives. Has general knowledge of, and is familiar with, how the facility's insurance coverage may apply to liability and casualty loss, which includes self-insurance funding, premium allocation, risk retention, and/or potential coinsurance/excess insurance coverage.

EDUCATION, TRAINING, EXPERIENCE, CERTIFICATION AND LICENSURE:

• Bachelor's degree required. Master's degree or higher in health care related field preferred.

• Experience in healthcare risk management, healthcare quality assurance and patient or colleague safety, health law or employment practices experience or other related healthcare experience.

• Medical malpractice risk management claims experience in a healthcare setting, knowledge of insurance policies and insurance company claims operations; Ideally, the candidate will have 3-5 years' experience in risk management.

• American Society for Healthcare Risk Management (ASHRM) Certified Professional in Healthcare Risk Management (CPHRM) required upon hire or completed within first 2 years

• RN preferred

SPECIAL EQUIPMENT, SKILLS, OR OTHER REQUIREMENTS: Strong written and oral communication skills, strong interpersonal, motivational and conflict resolution skills. Broad-based knowledge of hospital related regulatory compliance requirements. Presentation skills, team player, negotiation/ crucial conversations skills and ability to influence change without direct authority.

WORK ENVIRONMENT AND HAZARDS: Office and/or Clinical Setting.

PHYSICAL DEMANDS: Sedentary work: requires sitting, standing, and walking.

WORK CONTACT GROUP: All services, employees, medical staff, patients, visitors, vendors, various regulatory and professional agencies.

SUPERVISED BY: Regional Director of Risk Management

SUPERVISES: None

CAREER PATH: Management

Responsibilities:

• With respect to HPL/GL, Property, D&O, Business Auto, Crime/ Fiduciary, and Flood exposures, employs/ exercises various systems and processes (i.e., review of event reports, requests for medical records, staff notification) to identify events presenting claim/ litigation potential (PCE).

• Collaborates with Clinical Risk Specialist in investigation of pt. and/or visitor events and provides report of investigation pertaining to new events, claims and legal actions. (Conducts medical record reviews, preliminary staff inquiries/ interviews/ fact finding, review of policies, procedures, protocols, standards of care, and pertinent literature as requested).

• Analyzes and processes complex or technically difficult medical malpractice claims through examination of clinical records and legal data to determine cases of potential or certain liability and advisability of defending or prosecuting lawsuits. Submits PCE notification within the appropriate reporting system.

• Collaborates with Claim Administrators and defense counsel concerning initial and ongoing indemnity and expense reserves, identification of key staff to be interviewed, provision of applicable standards of care, policies, procedures, protocols, germane literature, copies of medical records/ reports, imaging studies, event reports and key documents. Supports defense attorneys, paralegals, claim administrators throughout the course of investigation, evaluation, disposition of cases.

• Reviews and analyzes claim and litigation experience and prepares reports for Clinical, Department, and Sr. Leadership staff identifying trends. Collaborates with Leadership in developing changed processes/ other loss reduction/ prevention strategies to improve care. Monitors/ measures effectiveness of process changes and outcomes.

• Assist the Regional Director of Risk Management in the reporting and management of first and third-party claims, particularly medical malpractice and general liability claims, and evaluate the extent and elements of exposure recommending appropriate actions for risk mitigation.

• Responsible for ensuring that discovery requests and all pre-trial documents are timely completed for defense counsel. Helps to support ACM, defense counsel and named employed defendants in the TH NY region during pre-trial preparations, depositions and mediations

• Participates in SPHP/SJH risk reduction/ safety initiatives (i.e., Midas, SSE/SEC Zero Harm, Best Practice Credentialing, Lessons Learned).

• Responds to complex external requests for physician/ allied health claim and litigation history information. Serves as a resource to the Regional Insurance Specialist in responding to routine requests.

• Serves as a resource to THNY staff and physicians. Refers to Legal counsel as appropriate in responding to Medico- legal questions/ inquiries.

• Monitors reserves and assists ACM in claim authority and settlement memo to TH NY leadership for approval.

• Recommends settlement strategies to leadership on GL claims, Asserted Demands for compensation, lost belongings and patient complaints

• Identifies and investigates claims for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost

• Maintains professional client relationships with all defense counsel.

• Routinely support facilities across TH NY by providing them with advice, best practice tools and templates, connecting facilities with each other for enhanced knowledge sharing, and researching information on their behalf.

• Reviews and analyzes all incoming colleague, patient and visitor occurrence reports for regulatory and insurance concerns.

• Identifies trends, patterns, and findings in claims.

• Shared responsibility for daily risk management counseling of providers and other clinic personnel as needed.

• Works with the Clinical Risk and Quality Improvement departments in identifying, analyzing, and making recommendations on risk management issues.

• Collaborates with the Director in managing and developing new Risk Management support programs and disclosure of unintended outcomes to patients and families as requested or required.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.