Senior Risk Management Specialist

UPMC•Pittsburgh, PA

1d•Hybrid

About The Position

UPMC Corporate Legal is hiring a Senior Risk Management Specialist to join our team! This role will work Monday through Friday during standard business hours. The position will have the ability to have a hybrid work schedule. Under the supervision of the Senior Manager, Corporate Risk Management, the function of the position is systematic management of potential as well as actual claims. Clinical data will by analyzed to determine areas of potential liability. Corrective actions will be developed with the assistance of clinical teams. The position will develop loss prevention programs in the area of professional liability to improve the quality of patient care while controlling liability exposure. This position requires critical thinking skills and the ability to provide direction. Must be able to collaborate with UPMC leadership in coordinating and managing individual projects. Do you have a pharmacist or RN license along with five years of healthcare experience? If so, this could be the next step in your career. Apply today!

Requirements

Bachelor of Science and a minimum of five years clinical or healthcare experience.
Experience in data/trend analysis and report preparation is necessary.
Experience completing and facilitating root cause analyses and healthcare failure modes and effects analyses.
This position requires an individual who is skilled in both verbal and written communication and demonstrates independence, leadership and the ability to make sound decisions.
This position involves the handling of very sensitive and confidential information.
Pharmacist OR Registered Nurse (RN)
Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.

Responsibilities

Monitor occurrence-reporting system by analyzing and identifying trends and developing corrective action plans in conjunction with appropriate management and staff.
Conduct high quality in-depth multi-disciplinary investigations of occurrences, which present significant risks in the area of professional liability and share information with appropriate management and staff.
Review and evaluate potential and current claims with relevant internal departments and make appropriate recommendations to Senior Manager for approval or denial of requests for reimbursement or adjustments of claims.
Establish files on potentially compensable events and submit to the Captive and Legal Services as appropriate. Participate in determining level of liability exposure and setting of reserves.
Responsible for compliance with the provisions of the Safe Medical Device Act and providing the necessary support systems.
Coordinate assigned professional liability legal suits with defense counsel.
Open and maintain legal files, complete and update Case Summary Worksheets on all assigned cases.
Gather information and requested documents to prepare draft Answers to Interrogatories, review Answers to Complaints and Interrogatories prior to Director's review and signature, schedule and attend meetings and depositions with hospital staff and defense counsel, attend trials and prepare written summaries for Director, review and present requests for settlement authority to Director.
Evaluate informational requests from department heads and coordinate with the Information Systems Coordinator necessary parameters to meet the request and facilitate report preparation.
Identify educational needs of the institution and develop specific educational programs for medical staff, nursing staff, allied health professional and others.
Develop written material for distribution to hospital staff, office practices and affiliated programs both on and off campus and present onsite educational programs.
Maintain awareness of current legislative activity affecting Risk Management by participating in local and national professional societies. Stay abreast of Risk Management trends by reviewing appropriate literature.
Coordinate Risk Management functions with the multiple disciplines and other Risk Management Peers.
Represent Risk Management on multi-disciplinary hospital committees and provide statistical information and reports as required or requested. Review and evaluate information from those committees for potential liability exposure. Seek appropriate corrective action plans from involved services and provide feedback to the committees.
Develop, with the Patient Relations staff, a coordinated approach to patient and family complaints.
Intervene at the request of UPMC Legal Services to provide information and guidance to staff regarding subpoenas and other legal matters.? Coordinate access to information or staff with outside legal counsel and insurance investigators.
Assimilate ideas and risk reduction strategies of UPMC Health System facilities into the Risk Management Program.? Identify and integrate best practices across the enterprise to improve the quality of patient care and reduce liability to the organization.
Develop relationships within the management structure in order to facilitate investigation and feedback.
Monitor occurrence reports, investigation, and resolution of significant events.
Evaluate educational programs of UPMC Health System facilities and mobilize resources for developing specific programs to address the needs of the clinical and management staff.
Establish a working relationship with staff of managed care organization and office site staff to facilitate integration of practice plans into the insurance program.
Serve as liaison between the Risk Management and non-Faculty physicians.? Identify specific needs of the hospital and/or office practices and develop Risk Management strategies to address those needs and act as resource for physicians and staff regarding medical legal issues.
Act as a resource/consultant for staff and affiliates for questions and concerns regarding professional liability issues. Provide twenty-four hour day coverage according to the department on-call schedule.
Participate in Patient Safety Committees of designated areas.