General Description of the Job ClassInitiate, coordinate, and manage all investigational and evaluation activities associated with professional and general liability occurrences and claim pre-litigation files. Negotiate resolution with the authority from the Director. Provide basic and complex preventive risk management assessment of processes, procedures, and programs, including inservice education, consultation, liaison activities, and on-call emergency assistance to providers.
Duties and Responsibilities of this Level- Investigate and analyze potential and actual professional liability and general liability exposures in the Health System; evaluate the extent and elements of exposure and recommend appropriate actions for risk mitigation.
- Investigate, evaluate and document pre-litigation occurrences and claims. Recommend resolution, and complete negotiation of resolution within authority granted by Director. Complete notifications and financial recommendations needed for compliance with tracking and insurer requirements, including insurance carrier notifications, reserve recommendations, and any federal, state, or entity reporting requirements (including SMDA, DataBank, etc.) as necessary.
- Review, code and investigate occurrence reports; recommend corrective actions based on individual reports or trends. Provide quality assurance and peer review referrals as appropriate.
- Provide in-service education on risk management topics, both standard basic education and complex focused topics as needed and/or requested.
- Provide on-call assistance for emergent/urgent risk management issues to all DUHS staff as needed. On-call duties are assigned on a rotation basis when possible.
- Prepare reports and analyses setting forth progress, adverse trends and appropriate recommendations or conclusions.
- Represent the Department of Clinical Risk Management on various DUHS and entity committees as required. Perform other related duties incidental to the work described herein.
- Required Qualifications at this Level
Education- Work requires a Bachelor's degree in business administration, public policy, hospital administration or a related field to acquire appropriate analytical, communicative and organizational skills. A Bachelor's degree in a clinical field (e.g. nursing, physician's associate) may be substituted if supplemented by additional courses or training in business or a related field (at least one year).
Experience- Work requires a minimum of four years experience in one or more of the following fields: patient care, public policy, health care administration, business administration, legal support or insurance/claims investigation and settlement.
- Graduate education beyond the bachelor's degree in hospital administration, business administration, public policy or a related field may be substituted for the required experience on a 1:1 basis.
Degrees, Licensure, and/or Certification- An Associate in Risk Management or Certified Professional in Healthcare Risk Management is desirable.
Knowledge, Skills, and Abilities- Customer Service Risk Evaluation
- Interviewing Skills Investigation Skills
- Medical Terminology
- Analyze Data
- Analyze Trends
- Risk Analysis
