Occupational Summary:

Initiate, coordinate, and manage all investigational and evaluation activities associated with professional and general liability occurrences and claim pre-litigation files. Negotiate a resolution with authority from the Director. Provide basic and complex preventive risk management assessment of processes, procedures, and programs, including in-service 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 SMOA, 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 inservice 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 necessary.
• Perform other related duties incidental to the work described herein.

Knowledge, Skills and Abilities

• Customer Service
• Risk Evaluation
• Interviewing Skills
• Investigation Skills
• Medical Terminology
• Analyze Data
• Analyze Trends
• Risk Analysis

Minimum Qualifications

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, Licensures, Certifications

Associate in Risk Management or Certified Professional in Healthcare Risk Management desirable.

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.