Healthcare Risk Manager

OVERVIEW:

Reporting to the Director, Patient Safety Risk Management the Senior Risk Manager develops, and implements risk management initiatives in accordance with state and federal laws. This position both administers and will operationalize Interfaith Medical Center’s risk management program on a daily basis, including management of clinical risk management activities; documenting, managing and analyzing risk management data; conducting targeted risk management education; implementing targeted risk mitigation strategies; and providing risk management consultation with the objective of promoting patient safety and loss prevention activity in protection of organizational assets. Under general direction, ensures timely processing of workers' compensation claims; evaluates accident reports to determine accuracy and completeness and to ensure adequate investigation. Responsible for claims monitoring and administration, report generation, and communication with employees, managers, insurance carriers, medical staff, and lawyers. Requires the handling of any and all sensitive business, employee and medical information in a confidential and appropriate manner. When applicable assist with a variety of Patient Relations functions as necessary.

RESPONSIBILITIES:

• Coordinates all aspects of the Hospital Risk Management Program. This includes, but is not limited to, the following areas: development, implementation and monitoring of Risk Management projects, policies and procedures, event analysis, root cause, common cause and apparent cause analysis.
• Develops and assists in the implementation of risk management program plans, and collaborates with appropriate departments implement changes in clinical practice, policy and procedure, and employee/medical staff behavior to preserve the IMCs assets, reputation, and quality care.
• Reviews and analyzes all occurrence reports for Risk Management, quality of care, regulatory and insurance concerns.
• Ensures compliance with legal and regulatory requirements, including but not limited to those regarding: Coordinating service of legal documents: Review of all Hospitals incident/occurrence reports, QA referrals, select patient complaints. NYS Department of Health/Office of Health Systems Management Patient Complaint and Article 28 (NYPORTS) process: NYS Office of Mental Health (OMH) reporting requirements: Reporting requirements of the NYS Commission of Quality of Care (CQC) for the mentally disabled.
• Provides support and incident response when there are concerns involving the quality of care rendered to a patient or general patient safety concerns. Such support may include facilitating effective communication between the patient/family and other members of the health care team relative to the disclosure of the event. May also assist with making an apology, managing patient and family emotions, and dispute resolution.
• While not engaged in direct patient care, may provide support to a patient or family after an adverse event or medical error.
• Fosters an awareness of patient safety and risk management practices and techniques through education and communication among senior management and the governing body, medical staff members, and employees at all levels.
• Reports all serious events and potential claims to Director Patient Safety Risk Management.
• Prepares various incident summary reports; provides all required documentation for investigations, activities, and resolutions related to the reported incident(s)
• Identifies organizational risk through trend analysis of incidents, incident letters, reports etc.
• Investigates events that led to real or potential patient harm. Identifies trends in reported event types and address these trends with the particular unit/department leadership.
• Coordinates with other clinical and administrative departments regarding risk management issues; Available to provide direction and coordinate counsel to physician, nursing and administrative staff regarding medical-legal issues. Monitors Risk Management cases and issues. Participates in special projects and performs other related duties.
• Assists Regulatory Affairs as warranted with DOH on-site surveys, OPMC and OPD inquiries.
• Evaluates accident reports, reviews medical reports, witness statements, department investigation results, and other documentation as related to the WC incident.
• Reviews documentation to determine whether medical bills and temporary total disability benefits should be continued; authorizes payment of medical bills and temporary total disability benefits upon receipt of proper documentation.
• Reviews accident reports to identify patterns of injury and to determine whether unsafe conditions contributed to the accident; advises Director and SVP of Risk of trends in injuries and proper safety procedures that may result in reduction of injuries; provides department with information that will aid in reducing accidents and improve safety.
• Maintain loss histories, and provide loss runs via computer interfacing with carrier.
• Every 90 days, initiates a status or a follow up on all open claims and attends claims reviews at either client or carriers location.
• Adheres to the highest standards of confidentiality and is well versed in the legal requirements of The Health Insurance Portability and Accountability Act of 1996 (HIPAA); The Americans with Disabilities Act of 1990 (ADA) requires employee medical and disability information be kept confidential and limits access to those employees who have a “business need-to-know” and employee information including, but not limited to “personal identifying information” (e.g., an employee’s Social Security number, home address or telephone number, salary, etc)
• Assists Patient Relations with the resolution of complaints when warranted.
• Performs related work as required.

QUALIFICATIONS:

Experience:

• 1 to 3 years of Worker's Compensation experience
• 1 to 3 years of Risk Management experience.
• 1 to 3 years of Insurance experience.

Education:

• Bachelor’s degree in Nursing, or Health Care Administration, or comparable related experience.

Knowledge and Skills:

• Working knowledge of medical terminology, body systems, and/or impairments and their disabling effects.
• Good judgment in interpreting medical facts presented by a physician and applying these facts in determining an individual's capacity to engage in gainful occupation.
• CPHRM, CPPS strongly preferred.
• Strong mathematical and analytical ability.
• Ability to constantly manage competing priorities.
• Must be able to adapt in a high stress environment with frequent interruptions.
• Constantly operate computers and other office equipment as required.
• Proficiency with Microsoft Office to include Excel, and Word.
• Good interpersonal skills a must.
• Ability to communicate effectively in English, both verbally and in writing.
• Good written and verbal communication skills.
• Ability to effectively interact with employees, managers, vendors, attorneys, carriers, etc.

Physical Requirements:

• Involves standing, walking, and talking.
• Frequent sitting for extended periods of time.
• May include some repetitive motions.
• Perform other duties as required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The statements herein are intended to describe the general nature and level of work being performed by employees, and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of Interfaith Medical Center (IMC).

IMC is an equal opportunity employer, it is our policy to provide equal opportunity to all employees and applicants for employment without regard to race, color, religion, national origin, marital status, military status, age, gender, sexual orientation, disability or handicap or other characteristics protected by applicable federal, state, or local laws.

Job Type: Full-time

Pay: $65,000.00 - $100,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: In person

Salary : $65,000 - $100,000