The Director, Risk Management has responsibility for specified programs within the enterprise Risk Management function of Stormont Vail Health including but not limited to development and management of key components of the organization’s risk management and safety programs across the enterprise. The Director’s work includes, but is not limited to defining and developing effective policies and processes to manage organizational risk, investigate and manage potential and actual claims, support staff and provider engagement in managing risk and safety issues and assure accurate and timely reporting to state and federal agencies. In conjunction with the Administrative Director of Risk & Safety, serve as a risk management resource to all health system divisions and departments.
Essential Duties and Responsibilities include the following.
Define, design and implement policies, processes and educational programs aimed at reducing organizational clinical and operational risk;
Investigate and assess incidents, adverse events, and potential claims that may present a risk of loss to the organization or an opportunity to improve clinical quality, reduce risk or operational safety
Participate in collaborative projects to propose, design and implement solutions/programs/protocols to minimize risk and liability exposure
Design and manage an effective claims management program for professional liability, general liability, property and other types of claims against the organization and its employees and providers while providing oversight to legal counsel, discovery and claims resolution processes; settle or resolve claims within approved
Collaborate and coordinate claims management and follow up activities with other members of the Risk and Safety team related to Workers’ Compensation or non-liability types of coverage;
Monitor claims operations to assure compliance with all insurance, legal, and statutory risk management obligations
Chair the organization’s statutory risk management committee and other enterprise-wide committees as assigned
Provide accurate, reliable and timely data reporting to meet insurance, regulatory, operational and risk financing needs; provide oversight, as assigned, to annual reporting and insurance renewal projects.
Conduct detailed and comprehensive risk assessments, analysis and develop recommendations for organizational actions to mitigate and manage organizational risks of loss
Work cooperatively with risk, safety, compliance and other specialized teams and their customers to minimize human, property, technology, clinical and financial risk
Serve as the organizational representative and manager of individual claims or litigated matters to assure timely and appropriate resolution.
Manage notices and communications with insurance carriers, consultants and other service vendors and partners to assure timely and appropriate communication and compliance with established policies.
Assess clinical events, near misses, close calls and related issues in order to identify, quantify, evaluate risk and make recommendations for improvement.
Under the direction of the Administrative Director, Risk & Safety, administer organizational loss prevention and loss control processes.
Conduct investigation of unanticipated/unexpected clinical outcomes, preventable clinical outcomes and potentially compensable events.
Provides risk management advice and guidance with the objective of maintaining patient safety, enhancing quality care and minimizing loss. Participates in the risk management on call schedule to provide after hours support on risk management and safety issues.
Support organizational accreditation and regulatory compliance including but not limited to the Joint Commission, CMS Conditions of Participation and Kansas Department of Health & Environment related to a variety of topics including but not limited to patient rights, EMTALA, disclosure and other matters.
Review, analyze and manages preventable patient harm, visitor accidents and other adverse events
Manage and document investigations related to hospital professional liability and general liability including conducting interviews with staff, insured physicians and management of pertinent documents and materials.
Oversee intake and file management of adverse events with harm and potential for harm in the Risk Management Information System in conjunction with the Risk & Safety Specialist and Verge IT Administrator
Extracts lessons learned and risk mitigation strategies from open and closed claims for shared learning through organized distribution channels.
Collaborates closely with patient safety, accreditation, medication safety, environmental safety, patient relations, ethics, medical staff services and others to identify, manage and resolve risk issues.
Develop and review policies with risk management implications.
Makes timely and appropriate referrals for clinical peer review, case evaluation and other assessment activities in accord with SVH policies
Actively participates in root cause analysis and various committees to design stregies to prevent error/harm and reduce loss.
Provides 24/7 on-call risk management coverage as scheduled and provides risk management consultation as appropriate.
Assists medical staff with internal and external reviews as appropriate.
Establishes and maintains protected and effective channels of communication.
Complete and file required notice of claim reports to insurance carriers with necessary documentation. Serve as liaison with insurance carriers and assist with investigation and settlement negotiation on claims and lawsuits. Review existing policies for coverage andexclusion clauses as required. Participate in managing the health system’s professional liability self-insured program.
Obtain, document and communicate with legal counsel any information necessary to support litigated professional and general liability claims management, support witness preparation and discovery activities.
Present educational sessions and in services on timely risk management issues to health system medical staff and employees.
Handle all communications promptly, professionally and accurately, while maintaining the confidentiality of all sensitive information.
To perform this job successfully, an individual must be able to perform each essential duty
satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Bachelors degree in business or related field required, JD preferred.
RN or other clinical experience preferred;
3 years of experience in claims management, risk management, clinical risk & safety or related disciplines or in roles related to compliance, regulatory or similarly sensitive matters and 2 years management experience required.
Experience in healthcare or other complex clinical or insurance environment preferred
Must obtain CPHQ within 2 years of hire to continue employment in this position.
CPHRM, Certified Claims Manager or equivalent certification preferred;
This position directly supervises others within the Risk/Safety Services Department; Indirectly supervises assigned project team members, representatives within other departments and activity leads to assure statutory and operational goals are met.
The work environment characteristics described here are representative of those an employee
encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Works indoors in a well-lighted, air-conditioned/heated environment. The noise level in the work environment is usually low to moderate.
The physical demands described here are representative of those that must be met by an
employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The individual is required to frequently remain in a sitting position and to reach with hands and arms. The individual is occasionally required to stand, walk, climb, stoop, kneel and crouch. While performing the duties of this job, the individual is regularly required to use fingers, hands and feet, talk and hear. The individual must regularly lift and/or move up to 10 pounds and occasionally lift and/or move up to 40 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Demonstrates supportive behaviors necessary for age-specific care as determined by specific department(s).
Please apply online at https://pm.healthcaresource.com/cs/stormont_vail/#/job/14416
Internal Number: Req # 26691
About Stormont Vail Health
Stormont Vail is an integrated health care system based in Topeka, Kansas, serving a multicounty region in northeast Kansas. It comprises Stormont Vail Hospital, Cotton O’Neil and Cotton O’Neil Pediatrics with more than 200 employed physicians and a variety of ancillary services. Stormont Vail achieved Magnet recognition for excellence in nursing services in 2009. Stormont Vail Hospital is a 586-bed acute care referral center in northeast Kansas. It is the product of the 1949 merger between Christ’s Hospital (opened in 1884) and the Jane C. Stormont Hospital and Training School for Nurses (1895). Stormont Vail Hospital and Cotton O’Neil joined in 1995 to form Stormont Vail Health. Stormont Vail has the region’s only Level III Neonatal Intensive Care and only verified trauma center.