Director, Risk Management (Sierra Vista)

Adventist Health•San Luis Obispo, CA

9d•$139,004 - $208,505•Onsite

About The Position

This position is responsible for organization administrative and risk management activities. This includes identifying, examining, and responding to risk-related issues and complaints involving the organization and its affiliates. The role involves managing or assisting in risk-related reviews to prevent financial loss, improve safety, and ensure compliance. It also includes collaborating and consulting on grievances, complaints, or concerns that have risk management implications, and monitoring organizational event reporting with a primary focus on incidents involving harm or potential liability. The Director will work with Patient Safety on trending to identify opportunities for improvement, manage and analyze risk management information data, and propose, recommend, and implement solutions and resolutions to risk-related issues and events. Follow-up on the implementation and impact of proposed solutions and resolutions is also a key responsibility. The role coordinates communication, disclosure, and early resolution after a safety event. It requires a general knowledge of organizational insurance programs and resources, and supports the Claims team in managing the organization's insurance program, including interfacing with internal and external legal defense counsel. The Director provides or assists in risk management training and education programs, identifies experts and topics that promote management of risk, and complies with risk management standards for purposes of accreditation, regulatory, and statutory compliance. The objective is to promote and enhance patient and employee safety, evidence-based and safe care, and minimize losses to protect the assets and reputation of the organization.

Requirements

Bachelor's degree in Nursing or other clinical field, risk management, legal or other related field: Required
Certified Professional in Healthcare Risk Management: within two (2) years of hire

Nice To Haves

Master's degree: Preferred
Seven years' experience in healthcare or general risk management: Preferred
Five years' leadership experience: Preferred

Responsibilities

Has oversight of Risk reviews of events and complaints that pose organizational risk and assists in appropriate responses.
Participates in patient safety event review meetings and conduct necessary follow up.
Directs and ensures efficient and adequate review analysis, and follow up are completed for high harm and potential compensable events (PCEs).
Analyzes event reporting data and makes recommendations for future review action.
Contributes and participates in activities designed to reduce risk exposure and improve safe patient care (e.g. Cause Analysis, Failure Mode Effects Analysis (FMEA) and performance improvement teams).
Facilitates risk assessments as needed to proactively identify and evaluate areas of risk.
Acts as a liaison and resource to market Risk Management to assess risk exposures in specific clinical and other situations (e.g. Facilities, Safety, Nursing, Pharmacy, Security, and Patient Relations).
Oversees reporting requirement of medical device and equipment failures.
Participates as member of various organizational councils/committees to provide risk management perspective and input for purposes of managing organizational risk and promoting safety activities.
Analyzes and monitors claims trends and develops risk mitigation activities and solutions in conjunction with market Risk Management, Claims team, and Legal department.
Manages claims process and ensures timely production and submission to internal and external legal counsels.
Coordinates with Claims team and internal and external legal counsel to successfully manage, mitigate, and resolve claims.
Oversees collection and dissemination of confidential claims information and data to authorized individuals.
Oversees and reviews periodic risk management claims reports as needed.
Coordinates the timely and accurate response to inquiries for claims history and coverage information.
Monitors evidence preservation (e.g. surveillance video, equipment, etc, and/or litigation holds).
Attends trial as site representative as directed by internal and external legal counsels.
Recommends payment for replacement of lost property after claims evaluation.
In collaboration with Claims team and internal and external legal counsels, negotiates settlement of small claims within administrative authority and advises billing department of appropriate action for unpaid accounts involved in litigation.
Safeguards documents obtained or developed for cause analysis to ensure documents/proceedings are protected from discovery.
Develops risk management program, policies and procedures and enhances existing risk management programs, policies, and procedures consistent with established organizational philosophies and values.
Collaborates with various departments to analyze data (e.g. complaints, grievances, claims, lawsuits) to identify priority topics and audiences for targeted training and education.
Utilizes external data (local, state, national) to identify high-risk topic areas and focus groups for targeted education.
Offers risk educational program on a regular basis and as requested including organization-wide presentations as well as specialty specific.
Performs other job-related duties as assigned.