Sr. Risk Consultant (RN)

OhioHealth•Columbus, OH

3d•Onsite

About The Position

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more – in our careers and in our communities. Job Description Summary: Given that the organization self-insures for professional liability claims, it is essential that the Senior Risk Consultant RN effectively engage in Risk Assessment, Analysis, Prevention, and Education activities intended to reduce/minimize the frequency and severity of losses, and subsequently, favorably protect corporate assets. To accomplish this, the Consultant's primary job focus evolves largely around the following activities; monitor for and capture all patient outcomes that have the potential to progress to professional liability claims against the hospital; analyze, interpret, and generate reports regarding the effectiveness and appropriateness of clinical care & treatment; works directly with complainants and claimants to investigate, analyze, and resolve allegations of professional negligence; where indicated, is given authority to negotiate financial settlements with claimants; is assigned to assist the General Counsel and external trial counsel in managing various aspects of formal litigation cases; functions as a Third Party Administrator/claims adjuster to manage, and as authorized, to negotiate claims settlements for (self-insured) General Liability claims; otherwise functions as the lead, on-site insurance contact for collecting and submitting claims reports/data associated with a variety of casualty lines of insurance coverage (e. g. property damage, fleet auto accidents, pollution/environmental exposures, etc. ); provides standardized and customized Risk Management specific in services and presentations to various audiences.

Requirements

Bachelor's Degree: Nursing (Required)
RN - Registered Nurse - Ohio Board of Nursing
Healthcare operations; proven complaint/grievance handling & conflict resolution skills; excellent negotiation skill set; proven successful problem-solver; competent in use of Microsoft office programs including Powerpoint; must be detail-oriented as well as people-oriented, and adept at multi-tasking; proficient with database management

Responsibilities

Patient Complaint/Claims management
Meets with patients, families, visitors, as well as clinical, ancillary, & administrative staff, and physicians, to assist/consult with, or take a lead role as indicated, in confronting and managing serious patient and visitor complaints & grievances, typically alleging substandard, or inappropriate professional care and treatment ; investigates the validity of the complaint/claim, analyzes medical records, interviews associates as indicated, negotiates and manages resolution of complaints and claims while balancing corporate interests and service recovery ; consults with the Risk Manager for case management, and settlement authority in negotiating and settling patient claims.
Unusual occurrences management
Analyzes all UORs & miscellaneous hospital reports on-line UORs, Attorney Requests for Medical Records, Quality variance reports, et c and identifies those having professional liability claim potential; initiates follow-up and/or investigative activities where indicated; reports significant findings to the Risk Manager, Legal, and Safety & Quality leadership; monitors for and reports significant UOR trends to . 2 Monitors for and generates dedicated reports of Safety incidents; notifies designated management/ leadership personnel of significant findings; actively participates in follow-up and investigation of incidents, participates in all Safety Event meetings/Root Cause Analyses; participates in Disclosure discussions with patients & families as requested by Hospital Safety & Quality leadership; completes clinical chart reviews and presents case summary at monthly Reserves meeting for significant/serious incidents.
Litigation management
Functions as the hospital/division liaison in assisting the General Counsel, in-house counsel, and external trial counsel with litigation-related activities; carries a litigation case load as assigned by the Legal department; completes clinical chart reviews and presents to the General Counsel for Reserving purposes; collaborates with and/or manages all requests for assistance from in-house counsel and external trial counsel in assisting with completion of interrogatories and production of documents requests, and other legal discovery activities as necessary; coordinates meetings between associates and trial counsel, schedules depositions of associates; attends/participates in litigation-related meetings & trial activities as delegated.
Liability & Casualty Insurance claims manager
Reviews, investigates, & analyzes general liability incidents & claims to determine the nature and extent of any hospital exposure/liability; in collaboration with the Risk Manager, Systems Director, and/or the General Counsel, for claims within the self-insured retention, is given authority to negotiate & settle claims; functions as the on-site insurance contact to capture data & submit claim reports for multiple other lines of casualty insurance coverage, i. e Property damage, fleet/auto accidents, pollution/contamination incidents; Assists the Risk Manager and Systems Director with data collection for the Corporations annual insurance renewal process; continually monitors the environment to identify issues having insurance coverage/ adverse exposure implications.
Meeting representation
Represents the Risk Management department at a wide variety of committee meetings including but not limited to, Safety, Security, Quality, Patient Safety, & Ethics and Compliance, and as a member of specialized task forces for the purpose of contributing perspectives/recommendations on Risk Exposure, Risk Reduction, and Risk Prevention.
Education & Training
Ensures the delivery of both proactive and reactive Risk Management education and training to a wide variety of hospital & ambulatory audiences and venues, inclusive of clinical, medical, ancillary/support services, &administrative personnel; Takes an active role in developing customized Risk Management in-services/presentation materials; may be engaged as a public speaker at professional organization seminars, and at academic centers, and /or to provide shadowing experiences for students.