Director, Quality & Risk Management

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Maintains responsibility for the direction and management of the department. Oversees the review of hospital and medical staff functions including assessing quality of patient care, evaluating use of resources, identity risk and safety factors for patients/visitors/staff and identity and assessing loss potential to the organization. Oversees Quality, Accreditation and Risk Management functions. Supervises and directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment.

Job Requirements:

Education and Work Experience:

• Bachelor's degree in a healthcare-related field or equivalent combination of education/related experience: Required
• Master's degree: Preferred
• Seven years' technical experience: Preferred
• Five years' leadership experience: Preferred

Essential Functions:

• Directs the development of programs/processes related to Quality Management, Environmental & Employee Safety, Licensure & Accreditation and Performance Improvement. Maintains responsibility for developing policy/procedure, monitoring performance, developing/reviewing metrics, assessing/prioritizing risk, conducting mock inspections and reporting results to senior management. Establishes, maintains and implements policies/procedures for department operations. Maintains a database of regulatory and accrediting agencies, including their defined role with the organization. Ensures staff is compliant with hospital guidelines and regulatory agencies.
• Communicates/educates staff regarding knowledge/information necessary to ensure Quality, Safety, Licensure/Accreditation. Develops and implements an ongoing preparedness regulatory agencies' plan. Directs data entry process for incident reports. Coordinates mock surveys, as indicated. Initiates and monitors efforts to preserve evidence (surveillance video, equipment memory, etc.) and/or litigation holds. Reviews charts and presents a monthly peer review report to medical staff coordinator for credentialing of physicians. Facilitates development of proactive programs to minimize risk. Initiates and monitors efforts to preserve evidence (surveillance video, equipment memory, etc.) and/or litigation holds.
• Risk Management / Liability Claims Liaison: Acts as Site Administrator for RADAR Claims Module (Potentially Compensable Event) and maintains legal case files. Investigates and reports potentially compensable events (PCEs) and asserted claims (demands for compensation, services or litigation) to the Trust pursuant to the corporate policy for reporting to the Trust. Provides investigation findings/information to claims staff including identity of location/site/clinic involved, identity (full name, job title) of involved parties, witnesses (how they are/were involved) etc., narrative description of the events, issues identified and recommendations for additional investigation. Investigates and responds (in writing) to requests from patients/visitors for compensation or payment for services, e.g., physical therapy, home health, specialist consultation, etc.
• Serves as primary contact for defense counsel and corporate claims staff. Facilitates/verifies discovery and requests for documents, information, interviews and depositions. Obtains concurrence for settlement, trial, etc. Works with legal counsel to coordinate investigations, process and defend claims against the facility. Obtains/maintains records and documents and provides them to defense attorneys for preparation of testimony in pending litigation. Safeguards materials obtained or developed for root cause analysis to ensure documents/proceedings are protected from discovery. Initiates and monitors efforts to preserve evidence, i.e., surveillance video, equipment memory, etc., and/or litigation holds.
• Attends trial as site representative, coordinates litigation activities involving site interviews, depositions, witness preparation, etc. Approves payment for replacement of lost property after claim evaluation. Negotiates settlement of small claims within administrative authority and advises collection department of appropriate action for unpaid accounts involved in litigation.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

JOB INFO

Job Category: Director

Job Shift: Day Shift

Assignment Category: Full-time regular

Pay Range:

Hiring Department: Quality Resources