The Risk Manager is responsible for designing, organizing, coordinating and implementing the Risk Management Program with the objective of controlling and minimizing loss to protect the human, physical and fiscal assets of the organization. Is an active participant in performance improvement data collection, activities, and functions to promote an integrated program, which ensures the provision of the highest quality of health care. Collaborates with personnel responsible for safety and security and actively participates in risk-related activities in this area. Provides assistance with claims investigation, management and litigation. Facilitates reporting of safety data/events. Evaluates risk management program(s) through the use of data capture, follow up and trend analysis and presents findings to appropriate committees. Assists with the development and implementation of initiatives, policies and procedures, including staff education activities, regarding risk reduction/elimination throughout the organization. Collaborates with multidisciplinary team on problem identification and resolution, cost containment issues, implementation of new services and systems/ performance measures.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Oversee the investigation of patient complaints and grievances and intervenes appropriately
Bring issues regarding quality to the immediate attention of Director of Quality and/ or appropriate hospital administration
Develop and maintain strong collaborative working relationships with the hospital and medical staff leadership
Accountable for and participate in the direction, implementation and evaluation of the Risk Management Program
Act as a consultant to all departments on risk mitigation activities
Collaborates with Director of Quality and Patient Safety to oversee and direct patient safety initiatives and develop a culture of safety
Direct the data collection necessary to produce risk related reports for administration, medical staff, and the Board of Directors that demonstrate effectiveness of the risk management program and patient safety activities
Support policies to minimize risk and help conducts “near miss,” Root Cause Analyses (RCAs), and failure mode effects analysis (FMEA) with Director of Quality and Patient Safety. Help facilitate all RCAs within the organization and includes all appropriate individuals
Helps establish a “Just Culture” of accountability in the organization through relevant Policies, Procedures and training
Responsible for the design, implementation and maintenance of an integrated, organization-wide occurrence reporting system.
Assures occurrence reporting system identifies unexpected/adverse occurrences.
Assures occurrence reporting system identifies systems problems with the potential for unexpected/adverse outcomes.
Directs and coordinates the claims management process for the organization.
Determines liability and probability of legal action for appropriate notification of administration, insurance carriers and/or appropriate government agencies.
Reports all claims to appropriate internal and external persons in a timely manner.
Obtains information at the request of a claims representative, adjuster and/or legal counsel in a timely manner in order facilitate a response to a complaint/claim or to facilitate resolution of the claim.
Receives notice of intent and legal summons served on medical staff and present/previous employees. Assist employees (defendants) in all phases of the claims process.
Develops internal claims file system and ensures that it is always current.
Ensures that the system for security of information and/or evidence in any actual or potential claim is followed.
Facilitates prompt payment for, or replacement of, lost property following appropriate approval.
Discusses/offers solutions, when possible to personnel involving actual or potential claims.
Provides feedback to appropriate organizational personnel in the effort to eliminate risks and improve performance and safety.
Interfaces with administration, medical staff, department managers and supervisors in developing, implementing and evaluating activities with risk implications.
Develops implements, maintains and evaluates compliance with programs designed to decrease risk.
Collaborates with Facilities Director and safety Officer to prevent/minimize the loss of property or assets.
Conducts annual Risk Management assessment and updates the Risk Management Plan.
Oversees Medical Provider Professional Liability Schedule for accuracy and completeness in collaboration with Medical Staff Office and administrative personnel.
Oversees auto, driver and property coverage for accuracy and completeness in collaboration with the Support Services Director.
Obtains insurance information and quotes for special events/circumstances and presents to appropriate staff for decision functioning.
Undergraduate degree in Nursing, Healthcare Administration, or related field required
Master's degree in Healthcare Administration or related field preferred
Fellow or Diplomat of American Society of Healthcare Risk Managers Associate in Risk Management (ARM) or Certified Professional in Healthcare Risk Management (CPHRM), preferred
Five years clinical and/or management experience in a multidisciplinary health care setting which includes a minimum of two years of inpatient experience preferred
Experience in risk management and/or professional liability claims management preferred
Should be knowledgeable about current State Laws and Regulations as applicable to facility
C. Special Skills/Knowledge
Excellent communication skills and evidence of collaborative practice
History of successful clinical and performance outcomes
Possesses thorough knowledge of insurance policies.
Assures all new staff members are oriented to the Risk Management Program during initial Orientation.
Evaluates the educational programs presented to medical staff and employee on pertinent risk management issues.
Knowledge of accreditation and federal and state regulatory standards is required
Proficient in email, Excel and internet programs
Ability to collaborate in a team environment and produce positive outcomes by motivating others
The new Martin Luther King, Jr. Community Hospital (MLKCH) opened in May 2015. MLKCH is licensed for 131beds and provides general acute care. It features an emergency department, a critical care unit, labor and delivery capabilities and include radiology and other ancillary services.
The new hospital offers a level of service that ensures a high quality, high tech and high touch hea...lth care experience for patients and their families regardless of citizenship status or ability to pay. Care is organized through a state-of-the-art, safe and secure electronic health record. In addition, MLKCH serves as a resource by supporting a coordinated and integrated approach to community wellness.
Los Angeles, CA
High Quality Inpatient Acute Care, Emergency & Intensive Care, Care Management, Maternity Services, Surgical Services, and Spiritual Care