Clinical Risk Mgr

Confidential Company  •  Milwaukee, WI

5 - 7 years experience  •  Patient Care

Salary depends on experience
Posted on 11/05/17
Confidential Company
Milwaukee, WI
5 - 7 years experience
Patient Care
Salary depends on experience
Posted on 11/05/17

151881

Responsibilities:

  • Primary Purpose
    • Develops and manages the effective implementation of systems and process for clinical risk management.
    • Provides support by leading the prevention, mitigation, improvement of clinical risk to its patients, visitors, volunteers, physicians, and employees.
  • Major Responsibilities
    • Develops and coordinates the processes for clinical risk identification, risk mitigation, risk investigation, and risk reduction; to include risksurveys, inspection of patient care areas, and chart auditing; assists in reviewing the facility to assess for loss potential.
    • Addresses patient complaints and grievances, working with clinical staff to meet applicable policy deadlines and with patients to resolve concerns, including risk management concerns. In conjunction with clinical and site leadership, participate or lead the grievance committee.
    • Implements and maintains risk management data collection and analysis systems necessary for optimal resolution of clinical risk. Manages, collects, and evaluates data concerning patient incident reports, aggregates data summaries, and develops monthly and quarterly riskmanagement reports that include trend analyses of incidents, claims, complaints and profiles. Utilizes multiple data sources, track and trend data to identify clinical risk.
    • Maintains incident and patient complaint reporting system. Investigates and follows up patient safety issues and potentially compensable eventsidentified through the incident reporting process. Facilitates root cause analysis investigations, Failure Mode and Effects Analysis (FMEA) methodologies, reporting of adverse events, and reporting of sentinel events to the appropriate parties. Coordinates any needed patient disclosure. Develops action plans to address any noted trends or particular events. Participates in peer review activities.
    • Collaboratively works with departments such as Infection Prevention, Quality and Medical Staff Services. Bring together multidisciplinary teams, including physicians, pharmacy and nursingto review events and determine interventions and solutions. Interface with clinical engineering in regards to recalls, and issues with supplies and/or equipment.
    • Conducts surveys, studies, and special projects to assist in proactive risk activities. Conducts periodic assessments of risk managementactivities to determine program effectiveness and assist in the development of corrective action plans. Collaborates with clinical, loss prevention and leadership in designing and conducting clinical risk management programs.
    • Assists in resolving treatment issues including patient refusal of treatment, consent issues, Against Medical Advice (AMA's), and issues surrounding end of life, advanced directives, and power of attorney as necessary. Acts as a resource for inquiries from physicians, nurses, and administrators regarding emergent patient care issues and loss control. Coordinates calls as needed with site, management and Clinical Riskleadership as needed.
    • Manages claims, interfacing with defense legal counsel, insurance adjustors, Legal, non-clinical risk management and Clinical Riskleadership. Investigates and analyzes actual and potential risks; assess liability and probability of legal action for potential notification ofinsurance carriers.
    • Notifies the liability insurance carrier of actual and potential claims and acts as a liaison with the insurance adjustor. Works actively with legalcounsel and the adjustor in investigating claims, developing defense strategy, and evaluating the monetary value of the claim. Advises billing department of appropriate action for unpaid accounts involved in litigation.
    • Notifies Legal, non-clinical risk management and Clinical Risk leadership of correspondence from attorneys and other outside sources and facilitates responses as necessary. Records, collects, documents, maintains, and provides Aurora attorneys and claims adjustors any requested information and documents necessary to prepare testimony in pending litigation.

Qualifications:

  • Licenses & Certifications
    • Registered Nurse license issued by the state in which the caregiver practices.
  • Degrees
    • Bachelor's Degree in Nursing or related field.
  • Required Functional Experience
    • Typically requires 7 years of experience in healthcare risk management, which includes experience in risk management principles, insurance/loss control, quality assurances issues, nursing processes, complex customer service, complaint resolution procedures and protocols, and claims management/insurance industry.
  • Knowledge, Skills & Abilities
    • Must be proficient in Microsoft Office (Excel, Word, Power Point, Access) or similar products.
    • Extensive knowledge of statistical methods, data analysis and presentation.
    • Excellent communication skills (oral and written, group, and one-on-one) and interpersonal skills.
    • Ability to work with a varied population of patients, staff, leadership and physicians.
    • Excellent problem solving, listening, customer service, and organizational skills.
    • Ability to work independently and in a team environment.
    • Must have the ability to influence change without direct authority.Ability to effectively manage multiple priorities in a fast paced environment.
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