Responsible for providing direct support to the Risk Manager in the daily management of risk management issues including: event reports, medical negligence claims, HIPAA and corporate compliance concerns. This position will also provide medical malpractice case analysis, evaluation and documentation as well as clinical support, review, analysis and evaluation of the HealthCare Partner (HCP) event report process.
Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
Reviews, analyzes, evaluates and categorizes all event reports submitted to Risk Management department.
Develops methodology to identify general risk trends and assists the Risk Manager in identifying specific trends and risks documented through the event report process.
Provides support to the Quality Improvement department and regional QI Specialists to establish necessary peer review or systems review of quality / risk-related instances identified through event reports, clinician communication, patient complaint or litigation.
Reviews and investigates potential litigation, and pre-litigation claims by preparing a liability report to include a chronology of events, interviews with insured staff, documentation of allegations, and claim evaluation.
Reviews and monitors medical negligence claims by participating in monthly claims review and assisting in setting and monitoring case reserves.
Assists the Risk Manager in researching and responding to questions regarding high risk issues, corporate compliance, HIPAA and other related issues.
Updates the Director, Risk Management on the status on complex cases.
Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Performs additional duties as assigned
Bachelor’s degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college.
Current California nursing license
1-3 years related experience
KNOWLEDGE, SKILLS, ABILITIES:
Knowledge of Microsoft Word, Access, Excel and the ability to learn and navigate proprietary database systems.
Ability to perform internet and other database searches for research.
Ability to type 50 wpm.
Statistical analysis skills.
Knowledge of managed care.
Ability to analyze and evaluate medical claims.
Ability to prioritize and respond quickly to high risk issues.
Good organizational skills.
Good interpersonal, verbal and written communication skills.
Ability to work independently.
MINIMUM JOB QUALIFICATIONS AND REQUIREMENTS
BS in related field or equivalent years of experience.
Knowledge, Skills and Abilities:
Ability to make independent judgments and pay close attention to detail.
Good oral and written communication skills essential.
Excellent interpersonal skills required.
Ability to communicate effectively with physicians, nurse, and other health care professional.
This job can be located in either El Segundo or Costa Mesa, CA.
DaVita Medical Group is a division of DaVita Inc., a Fortune 500® company, that operates and manages medical groups and affiliated physician networks in California, Colorado, Florida, Nevada, New Mexico, Pennsylvania and Washington. A leading independent medical group in America, DaVita Medical Group has over two decades of experience providing coordinated, outcomes-based medical care in a cost-effective manner. DaVita Medical Group’s teammates, employed clinicians and affiliated clinicians provided care for approximately 1.7 million patients. DaVita Medical Group’s leadership development initiatives and social responsibility efforts have been recognized by Fortune, Modern Healthcare, Newsweek and WorldBlu. For more information, please visit?DaVitaMedicalGroup.com.
We offer a competitive wage and a comprehensive benefits package which includes insurance programs covering medical, dental, vision, life, long-term disability, paid time off, education reimbursement, and a 401(k) plan.
DaVita Medical Group is an equal opportunity/affirmative action employer. As such, DaVita Medical Group makes hiring decisions solely on the basis of qualifications and experience, and without regar...d to age, race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.
We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.
DaVita Medical Group will consider qualified applicants who have criminal histories in a manner consistent with the law.