MEDNAX has grown from a single medical practice to a trusted health solutions partner with more than 10,000 employees and a presence in 50 states. Through our family of companies, we provide:
physician services spanning the continuum of patient care
revenue cycle management solutions
performance improvement consulting
We invite you to grow with us and help shape the future of health care.
The Clinical Risk Manager / Risk Nurse Consultant will provide Risk Management support under direction of Director, Risk Management.
ESSENTIAL DUTIES & RESPONSIBILITIES:
Provides clinical risk support, expertise, and service to facilitate the management of the overall operation and strategy of clinical risk management in a corporate setting.
Investigates and coordinates the review of reported risk events, patient adverse events, and sentinel events received by healthcare professionals and business partners across a national platform.
Manages ongoing analysis, development and implementation of methods and systems to improve overall safety, efficiency and effectiveness of clinical risk management services and functions.
Analyzes track and trend incident report data; identifies organizational process improvement needs and facilitates multidisciplinary efforts to provide education and training to support quality improvement and patient safety.
Participates and assists in claim management activities, including conducting internal reviews with counsel and committee members.
Assumes responsibility to collaborate with hospital partners, medical directors, and the corporate risk operations team to support an enterprise risk program.
Receive, timely investigate and record event and analysis in risk system Adverse Occurrences, risk related peer review matters and patient complaints and analyze for risk liability exposure.
Provide tracking and trending analysis of adverse events and/or malpractice claims, identifying trends for quality purposes. .
Conduct Sub-specialty Review following the established guidelines. Present resolution strategy for high exposure and low/moderate defensibility within 60 days of review.
Conduct, develop and make recommendations for educational Risk Management orientation training as assigned.
Timely manage the reporting of and final outcomes for healthcare providers involved in license investigations.
Manage requests for depositions of the healthcare providers, follow up and close matters within 30 calendar days of conclusion of the deposition. Identify and make recommendation for management of matters at risk for litigation,
Collaborate with Compliance and Patient Accounts Department on Highly Sensitive Billing Disputes (HSBD) that have quality of care concerns or have a potential malpractice liability exposure.
Provide case management per established Claim Handling Guideline, collaborate with carriers and defense attorneys and make strategy recommendations for medical malpractice claims, including but not limited to all pre-acquisition and commercial claims, as assigned.
Management should include requesting quarterly Reports of Counsel, communications with the healthcare professionals, timely updating Risk system, reporting all mediations and trials, and reporting any potential adverse verdicts, judgments or settlements over the covered policy limit.
Participate in monthly claim review discussions and present defense or resolution strategy to Director.
Timely provide analysis of Production documents to defense counsel for medical malpractice cases, according to litigation guidelines. Analysis should include but not limited to:
Investigate dental claims, make recommendation for management, referral to the insurance carrier or resolution. Obtain approval for payments and prepare Releases or other communications as assigned.
Management and coordination of Provider Peer Support Program.
Other duties as assigned.
Required: RN Degree with 3 years' experience in risk management
Preferred: Certified Professional in Health Care Risk Management (CPHRM)
Four-year college or university program certificate; or two-to-four years related experience and/or training; or equivalent combination of education and experience.
Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to write speeches and articles for publication that conform to prescribed style and format. Ability to effectively present information to top management, public groups, and/or boards of directors.
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
MEDNAX IS AN Equal Opportunity Employer
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status