Risk Program Manager

POSITION SUMMARY

This position is responsible for the assigned entity’s risk management activities, which includes, but may not be limited to a general knowledge of corporate insurance programs, administering the risk management program on a day-to-day basis, managing and analyzing risk management data, and conducting risk management educational programs, complying with risk management related standards by The Joint Commission (TJC )and other accrediting and regulatory agencies with the objective of enhancing and promoting patient safety, quality of care, and minimizing losses to protect the assets of the facility. This individual participates in formulating policy and / or organizational changes, but must seek advice and approval from higher authority. While the Risk Manager may be responsible for the functions in the Risk Specialist job description, this position most often provides guidance, oversight and offers overall program direction to staff performing these tasks in the Risk Specialist position. Provides information and data for the development of the budget for the assigned entities and obtains management approval.

CORE FUNCTIONS

1. Develops, coordinates, and administers systems for risk identification, investigation and reduction. Performs risk assessments in various clinical settings and inspects patient care areas. Maintains awareness of legislative activities that may affect risk management programs in assigned entities.

2. Develops, implements and monitors entity-specific risk management plan. Develops and monitors progress on annual entity-specific risk management goals. Collaborates with quality and patient safety representatives in developing performance improvement plans, indicators and goals.

3. Assumes an active role in planning and decision making efforts through membership in various entity committees : hospital, clinic, and ambulatory. Provides consultative advice to senior management, administrators, physicians, relevant internal department, nurses, and other personnel regarding patient safety and risk management issues.

4. Works in conjunction with the patient safety officer, service excellence, and management in the investigation of potential or actual events / concerns. Participates in root cause analysis investigation and reporting of adverse drug events and sentinel events to the appropriate parties.

5. Collects, evaluates and presents relevant data on risk management claims data to CEOs, administrators, physician committees, leadership groups, department heads and Human Resources; this includes aggregate data summaries, trend analyses, and claims and litigation information. Provides analysis of risk data for all levels of management. Shares risk management information and issues through participation in patient safety initiatives and various hospitals, medical staff and / or other similar entity-specific committees.

6. Responds to professional liability and facility liability questions posed by physicians, administrators, nurses, and other personnel regarding emergent patient care issues to minimize risk and control loss. Assists in resolving treatment issues, including patient decisions made against medical advice (AMA), refusals of treatment, and consent issues; initiates court orders as appropriate via in-house and outside legal counsel. Participates in the process of disclosure of medical errors. Provides assistance to departments in complying with TJC or other accrediting agencies, regarding risk management related standards. Responsible for being on call as scheduled.

7. The risk manager is responsible for development of loss prevention programs that may include but not limited to patient safety issues. Periodic inservices and routine orientation may be conducted for facility employees / medical staff regarding health care risk management and related subjects. Recommends appropriate revisions to new or existing policies and procedures to reduce the frequency of future occurrences; recommends ways to minimize risks through system changes; reviews and revises facility policies as appropriate to maintain adherence to current standards.

8. In litigated claims, assists Business Health Claims team and legal counsel in accessing facility records and personnel. May assume an active role in release of records and information in response to subpoenas, court orders, attorney requests, state and federal agency investigations, and other inquiries from outside sources.

9. Internal customers include senior management at assigned organization, patients and their families, administrators, physicians, relevant department heads, all types of employees, Business Health regional claims managers, region leaders, and the organization as a whole. External customers include federal agencies, the legal system such as the judiciary, outside legal counsel; state agencies, various professional boards; state and local law enforcement agencies; physicians and other health care providers.

MINIMUM QUALIFICATIONS

Must possess a knowledge of risk management as normally obtained through a bachelor’s degree in nursing or related field.

CPHRM is required within two years of hire.

Four to five years in Risk Management or equivalent experience required. Must possess strong written and oral communications skills, presentation skills, team player, ability to influence change without direct authority, and negotiation skills. Must demonstrate and apply knowledge of federal and state statutes specific to health care, medical terminology and hospital or department policies, procedures and practices. Requires ability to manage and negotiate in emotional and confrontational situations, with sensitivity to operations and culture of facilities and organization as a whole.

PREFERRED QUALIFICATIONS

RN preferred. QA, Patient Safety, CPHQ, and / or ARM preferred; patient safety certification preferred.

Additional related education and / or experience preferred.

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