Senior Clinical Risk Manager

University of Washington Medical Center

3d•$125,004 - $134,076

About The Position

The Senior Clinical Risk Manager’s primary responsibility is to proactively manage adverse events, including the identification and management of those with professional liability exposures, provide consultation regarding clinical risk management matters, and develop and deliver risk management education programs as assigned, within UW Medicine and the University Schools. The Senior Clinical Risk Manager works in close collaboration with UW Medical Directors, Chief Nursing Officers, individual health professionals, directors, and managers and in close cooperation with Patient Relations, Patient Safety, Quality Improvement, Compliance, and/or billing staff for assigned UW entities. This position works to prevent and mitigate patient harm and the associated potential professional liability exposures and to ensure regulatory compliance with respect to the management of adverse patient events and patient grievances. The Senior Clinical Risk Manager will be the lead for managing risks for UWMC's Behavioral Health Center at the Northwest Hospital Campus but will also have responsibility for managing risks at UWMC and at other facilities as assigned. Objectives: Identify and manage and/or collaborate in the review of events involving patient harm for the purpose of improving patient safety and/or the quality of the care. Enhance the relationship between patients and those involved in patient care delivery via the successful management of patient grievances involving alleged harm. Provide proactive clinical risk assessments and advice as component of the relevant UW quality improvement program. Develop and deliver clinical risk management education programs for the purpose of medical malpractice prevention as part of UW Medicine coordinated quality assurance programs. Identify potential claims to reduce their adverse effects on the organization’s human, physical and financial assets and collaborate as necessary with others in the management of claims. This position provides both strategic direction and direct intervention in the most sensitive and highly confidential patient care situations encountered in the clinical enterprises. It is the lead risk manager for patient care events at the Behavioral Health Center at the Northwest Campus, in addition to regular assigned risk manager responsibilities at UWMC and other locations such as Harborview Medical Center as needed. This position reports to the Associate Director, Clinical Risk Management, for UWMC, and to the Associate Director, Clinical Risk Manager for Harborview Medical Center for entity-specific activities. It interacts directly with physicians, nurses, quality improvement and patient safety officers when patients are harmed (death, serious surgical complications, etc.) in the course of care delivery. The Senior Clinical Risk Manager interviews and coaches faculty and staff, provides advice to health care executives about the management of serious patient harm events and regulatory compliance associated with them, and is the primary intermediary with patients and their families if a formal grievance is filed. The position requires highly developed analytical skills, familiarity with the clinical environment and the complexities of health law, particularly in the field of behavioral health, as well as excellent communication skills to gain the trust of physicians to effectively deal with these types of situations. The credibility of the individual is critical to the management of events as well as more proactive strategies provided through consultation and risk management education programs. This position provides direct support to the University schools' clinical operations. Failure to appropriately manage the situation when patient harm occurs could result in significant adverse publicity and reputational harm to the University and to the relevant clinical entity. Failure to appropriately manage patient harm events, via mitigation or prevention, increases the University's exposure to medical malpractice litigation. This area of litigation is the most expensive from a risk financing perspective.

Requirements

Master’s degree in nursing, behavioral health, psychology, or MPH
Four – five years’ experience managing professional liability events in a health care risk management setting and/or professional liability claims experience.
Equivalent education/experience will substitute for all minimum qualifications except when there are legal requirements, such as a license/certification/registration.

Nice To Haves

Three – five years’ experience as a clinician (preferred) and/or equivalent work experience in a health care setting.
Three years’ experience working with the public to resolve disputes or equivalent work experience.
Three-five years’ experience developing and using databases to report information.
Risk Management credentials, such as the Associate in Risk Management (ARM) or certificate program in Healthcare Risk Management (CPHRM).
Experience-based knowledge of medical professional liability exposures and laws, investigation, and negotiation techniques.
Thorough knowledge of the principles and practices of Risk Management.
Effective and professional oral and written communication skills
Proven ability to organize and analyze data and to problem-solve using continuous quality improvement techniques to improve processes and outcomes.
Demonstrated familiarity and ability to use Word & Excel and similar software products independently.
An understanding of health care regulations and how they affect patient care delivery systems.
An understanding of behavioral health care regulations.
Experience-based knowledge of customer service techniques.
Proven ability to work effectively in a team environment with rapidly shifting priorities.

Responsibilities

Create and maintain individual event review documentation and aggregate data about events (clinical incidents and accidents) involving patient harm or risks to patient safety to support on-going clinical risk management/mitigation and quality improvement initiatives.
Review event (clinical incident/accident) reports on a daily and on-going basis to identify and manage or collaborate with others to manage events involving patient harm that may also be associated with professional liability exposure
Maintain accurate coding and analysis of events to support patient safety and quality improvement initiatives and compliance with regulations
Maintain information about individual events to support the management of claims by the UW Claims Managers
Collaborate with others to create and maintain reports for entity Boards of Directors, quality improvement, patient safety, and clinical risk management committees.
Ensure compliance with federal and state laws related to clinical adverse events, including TJC, DOH, CMS, OFM, and FDA requirements.
Identification of Sentinel/Adverse Events as defined by TJC and DOH, CMS-defined Hospital-Acquired Conditions, and Medicare Non-coverage Decisions in collaboration with the entity quality improvement staff, compliance, and billing staff and in accordance with the Policies & Procedures of the UW clinical entity or University Schools.
Identification and development of information related to equipment failures to ensure compliance with the reporting requirements of the Safe Medical Devices Act.
Identify all events that meet requirements for reporting to other state or federal agencies to ensure that reporting occurs and is tracked.
Liaison with Patient Relations, Quality Improvement staff, Patient Safety Officers, Medical Directors, Chief Nursing Officers, UW Claims Managers, and health professionals to respond to patient and family grievances involving alleged patient harm related to quality of care or allegations of lack of informed consent.
Collaborate as needed with UW compliance officers regarding patient privacy complaints and bill waivers.
Collaborate closely with Patient Relations staff within the UW Medicine entity and/or University Schools to ensure the timely review, acknowledgement, and response to patient grievances within the Policies & Procedures of the entity.
Refer patient grievances that are not resolved to the Grievance Committee as required
Develop responses to patient grievances in consultation with the involved health professionals and their clinical leadership to ensure patient satisfaction, integration with entity quality improvement and peer review processes, and compliance with CMS and DOH standards.
Collaborate in the review or conduct a review of events involving patient harm under the auspices of the relevant QI Committee to identify quality improvement opportunities.
As a part of the QI review process, identify potential professional liability exposures and report to the UW Liability Claims Manager.
Document reviews, including: Identification and preservation of relevant entity Policies & Procedures related to the event; Interviews and/or reports obtained from the health professionals involved in the quality improvement review of event; Preservation of equipment or other evidence within the established Policies & Procedures of the entity; Medical literature searches; Medical record reviews; and Consultation with the Attorney General’s Office as necessary.
Demonstrate knowledge and understanding of patient privacy rights.
Maintain confidentiality of all medical, financial, or other sensitive materials and information in printed, electronic or verbal form, which may jeopardize the privacy of patients.
Access and use the minimum necessary patient identifiable information to perform job responsibilities and duties and only for authorized purposes.
Demonstrate knowledge and understanding of and maintain confidentiality of employee information and UW Medicine strategic plans and initiatives, financial information or other sensitive materials and information in printed, electronic or verbal form, which may jeopardize employee rights or organization’s operations.
Access and use the minimum necessary employee and organization information to perform job responsibilities and duties and only for authorized purposes.
Collaborate with others and provide input, interpretation, and review of organizational policies, procedures, protocols, and process development to support equitable policies and procedures in the delivery of patient care.
Advise health professionals about documentation, informed consent and communication strategies
Recommend and manage administrative adjustments to patient accounts within the compliance policies of the UW clinical entity and/or University Schools
Consult with the Attorney General’s Office about events as needed to facilitate the provision of legal advice to health professionals.
Conduct clinical risk assessments to identify the potential for patient harm and to recommend strategies to mitigate them.
Participation on committees, task forces, and in risk management education programs as assigned, including preparation of materials for discussion at committee meetings such as UW Medicine or entity Risk Management and quality improvement committee meetings and independent preparation and delivery of educational materials and programs.