Responsible For: Risk Management within a Facility or Market Area
Under the direction of the Mercy Health Market Director of Risk & Insurance the Risk Manager (“Manager”) supports the goals of the Mercy Health Insurance & Risk Services Department within the Facility, and shares accountability for achieving program goals and objectives. The Manager assists with the enterprise wide risk management program for acute and non-acute care centers, physician practices and ancillary business entities when Mercy Health is the majority owner. Specific Risk Management responsibilities may include but are not be limited to:
collect and analyze risk management data
identify and minimize loss exposures in order to protect the assets of the Facility
maintain a general knowledge of the Facility’s insurance programs
conduct risk management educational programs
comply with regulatory and accreditation standards
manage retained losses through standardized processes
works in conjunction with Mercy Health Claims Department and outside defense counsel in the defense of claims
other duties as assigned
Under the supervision of the Director assists with loss prevention strategies and initiatives. These strategies include proactive risk activities such as risk assessments, educational programs, consultations and ensuring compliance with the multiple laws and regulations affecting patients, visitors, employees and the community we serve.
Conducts risk management surveys and studies and responsible for implementing action plans to address risk exposures
Participates in the event management process including initiating and participating in the Event Investigation Team; coaching leadership and physicians in the apology and disclosure process; attends the Root Cause Analysis; may assist with the early liability review process
Adheres to Mercy Health policies regarding serious reportable events and sentinel events
Contributes in establishing loss prevention initiatives related to non-clinical risk reduction and mitigation techniques by coordinating the commercial insurer’s recommendations for loss control
Complies with various codes, laws, rules and regulations concerning patient care, including those mandated by state and federal agencies, incident reporting, also includes investigative activities with federal, state and local enforcement authorities
Presents educational material to administration, medical staff, nursing personnel, and other department personnel on topics related to risk management
Acts as a consultant and answers medical/legal inquiries of physicians, nurses and administrators regarding emergent patient care issues, insurance & claim questions
Participate in Patient Safety WalkRounds, Collaboratives, and other patient safety activities
Oversees the effective management of SafeCARE reporting and documentation. This includes analyzing trends and identifying reports that may indicate a significant event has occurred
Takes “On call” responsibility related to risk management issues and adverse events as scheduled
Under the supervision of the Market Director performs the initial risk management investigation and if a claim is expected or received assists the Claims Managers and external defense counsel in the discovery process.
Identifies and collects documents necessary to respond to interrogatories and requests for production of documents.
Keeps Market Director apprised of significant claims and upcoming Trials
Enters potential and actual claims in the Claim Data Base and maintains the investigation file according to the Risk Management Plan
The Risk Manager maintains a general knowledge of, and is familiar with, the facility’s coverage for professional liability, property and casualty loss, including CHP Insurance Ltd, risk insured retention, and coinsurance.
Participates in the Facilities insurance programs by ensuring exposure data is maintained to facilitate renewal of the Mercy Health centralized insurance program
Communicates any new exposures to avoid coverage gaps
KNOWLEGDGE, SKILLS & ABILITIES
Bachelor’s degree or equivalent experience in Healthcare or Insurance related field required
Attainment of CPHRM designation within five years of hire
Demonstrated understanding of the risk management process, principles and practices essential
Excellent report writing and public presentation skills
Excellent interpersonal relations and communications skills (verbal, written, and listening skills). Ability to build collaborative relationships with internal and external customers. Able to establish excellent rapport with physicians and other health care executives; must have a diplomatic and consultative approach
Ability to conduct risk assessments, and pro-actively identify risk exposures
Ability to manage, aggregate and analyze data
Attention to detail and highly effective time management skills
Experience with clinical performance improvement using traditional and evolving quality improvement tools and techniques (e.g., RCA, PDSA/Rapid Cycle Improvement, Patient Safety WalkRounds, FMEA, etc.)
Action-oriented, shows initiative, enthusiasm and motivation toward the principles of patient and resident safety. Familiar with adverse event reduction methodologies and their successful, measurable applications
Strong organizational and project management skills to support implementation of system-wide risk initiatives
Understanding of various regulatory and accrediting bodies and laws affecting patient care
The ability and willingness to identify with, share in and have commitment to the philosophy, mission, values and vision of our Sponsors and Catholic Health Partners
Risk and Insurance Services is a professional service program established for the purpose of identifying, preventing, responding to and recovering from events which may adversely affect our operations, financial security, as well as our patients, visitors, employees, medical staff and volunteers.
Risk and Insurance Services has three primary functions which include: 1-Managing the self insuran...ce and commercial insurance plans through partnership with the markets, 2-Respectful claims management, 3-Pro-active risk management to include the minimization of harm to our patients, visitors, employees and the organization.
Services provided include, but are not limited to, the following: Consultations regarding our primary functions, education sessions for clinical and non-clinical topics, just-in-time training for apology and disclosure, support for new initiatives, Root Cause Analysis participation, Risk assessments