Director of Risk Management - Full Time
At Steward Health Care System, we are committed to improving the health of our communities by delivering exceptional, personalized health care with dignity, compassion and respect. Our continued focus on the patient experience informs our caregivers in how to provide care that is respectful of and responsive to individual patient and family preferences, needs and values.
We dedicate ourselves in the communities we serve to delivering affordable health care to all and being responsible partners. No matter what your role, as a member of the Steward family, you are a specialist in the making of every patient and family feel right at home, every co-worker a key to our success, and ever referring practice, a team of prized colleagues.
In support of this, we commit ourselves to the following values:
If you are seeking a fast-paced, challenging position in an organization committed to achieving and maintaining a standard of excellence in all we do, our organization may be a good fit for you.
Plans and directs the insurance and liability issues for the facility staff, patients and vendors. Responsible for providing clinical and non-clinical information about Patient Safety, Risk Management, Insurance, Claims, and other related Risk Management activity. Responsible for management of the Health System's insurance and associated risks, communicating with the internal senior administrative team and the external insurance brokers and agencies to ensure accurate, continuous coverage.
Excellent interpersonal and communication skills (oral and written) required. Excellent customer service skills required. Excellent organizational skills required. High level critical thinking skills and problem resolution skills required. Computer skills with word processing, graphics, presentation tools and database programs required. In depth knowledge of regulatory and accreditation compliance (ADA, OSHA, PSDA, SMDA, EMTALA, HCQIA, HIPAA, JCAHO, CARF, Department of Health-all divisions, and other regulatory agencies).
- License RN (preferred)
- BSN (preferred)
- Certification in Healthcare Quality (CPHQ) and/or Healthcare Risk Management (CPHRM), preferred.
Job Responsibilities and Major Duties:
- Conducts periodic system analysis to identify patterns/behaviors that increase risk for the organization.
- Collects, evaluates, distributes, and communicates information relating to patient activity, including aggregate data, trends and summaries.
- Develops and maintains risk management information for areas within the organization. Communicates this information to department heads/managers as necessary.
- Assists department heads in developing risk management programs within their departments.
- Provides administrative summary reports on incidents, claims, etc.
- Provides routine orientation to all staff.
- Develops and provides educational in-services for staff as needed based on identified opportunities for risk reduction.
- Analyzes actual and potential risks in the organization.
- Participates in committees relating to patient service delivery to identify areas of increased risk/liability.
- Provides recommendation for changes in policies and procedures to reduce risk or achieve compliance with regulatory agencies.
- Manages organizational system for incident reporting.
- Review all incident reports, investigates as appropriate, identifies level or risk/liability, and communicates appropriate information to legal counsel and administration.
- Ensures accuracy and security of the clinical/medical record, patient billing records, policy and procedure, incident reports for any claims.
- Coordinates and directs release of information in response to subpoenas, court orders, attorney request, state and federal agency investigations, and other inquiries from outside sources.
- Works with legal counsel to coordinate the investigations, processing, and defense of claims.
- Manages insurance policy coverage. Negotiate provisions for coverage and exclusion. Analyzes coverage dates for each plan. Anticipates expiration of insurance. Responds to changes in insurance activity as well as changes in the organizational management, operations, activities, or properties, and ensures organization maintains adequate and continuous coverage.
- Communicates with insurance carriers as necessary, acting as the organization representative. Completes all documentation as required for all insurance plans.
- Communicates with administration regarding opportunities of increased risk, or loss of coverage, as well as any changes in the insurance coverage.
- Manages and reports loss run information.
- Reports related incidents and required follow-up information to the Department of Health as required by regulation. Coordinates investigation of any reportable incidents and resulting development of corrective plans.
- Maintains awareness of legislative and regulatory activities.
- Promotes compliance with regulation including, but not limited to: ADA, OSHA, PSDA, SMDA, EMTALA, HCQIA, HIPAA, HCFA/CMS, JCAHO, CARF, Department of Health-all divisions, and other regulatory agencies.
- Serves as Chair of the Patient Safety Committee.
- Ensure the investigation of all reports of serious events and incidents.
- Take action as is immediately necessary to ensure patient safety as a result of any such investigation.
- Report to the Patient Safety Committee regarding any action taken to promote patient safety as a result of investigations.
- Ensure the disclosure of serious events to patients and/or families is carried out in accordance with organizational policies, regulations, and laws.
- Serve as the direct link to the Chief Executive Officer and Board of Directors on all matters related to patient safety.
Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.
Please note, our Sharon Regional Medical Center is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment - with confidence and without fear. Our Safe and Ready program consists of a rigorous [five-point] standard ensuring patient safety, confidence and convenience: Expanded hours will allow previously canceled procedures to be scheduled as quickly as possible. Any COVID-19 related care takes place in designated areas away from other patients and their famines. Emergency Departments are reorganized to be a safe place to treat all emergency patients. A stringent cleaning policy is required for patient safety. You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.