Reporting directly to the Vice President Legal Services, the Director of Risk Management and Insurance Services is responsible for providing system-wide leadership for the organization’s risk management program and for managing internal processes to support the organization’s self-insured programs. Works collaboratively with the VP of Legal Services to develop, and ensure the effectiveness of, systems to identify, evaluate, and mitigate risk for the organization on an ongoing basis, ensuring that risk mitigation strategies cover both hospital-based and ambulatory services, including employed physician practices. Ensures that the organization's risk management policies, procedures and practices are in compliance with all applicable laws and regulations. Provides oversight for the management of insured claims and all claims management processes that support the organization’s self-insured programs; effectively utilizes both internal and external claims management resources. In collaboration with VP Legal Services and the Chief Financial Officer, responsible for managing system-wide commercial insurance programs and for continuously evaluating the organization’s portfolio for coverage gaps and mitigation strategies.
Plans, leads and evaluates the organization's system-wide risk management program. . Ensures effectiveness of program to reasonably detect, prevent and mitigate organizational risk.
Develops and implements systems to complete organization-wide risk assessments on an ongoing and systematic basis. Ensures that appropriate action plans and mitigation strategies are developed in response to assessment findings. Works collaboratively with management, physicians and staff in both assessing and mitigating risk.
Serves as internal resource for risk-related patient care questions and/or issues (e.g., consent, guardianship, patient capacity, disclosure of adverse events).
Ensures an effective process for identifying, reporting and managing incidents, claims, potentially compensation events and/or law suits. Provides for effective coordination with third party claims administrators, as well as internal and external counsel.
In collaboration with CFO, VP Legal Services and external broker, continually evaluates the organization’s insurance portfolio. Oversees process for completion of all commercial insurance applications.
Education -Master's degree in health related field required. Juris Doctor strongly preferred.
Experience - Minimum of 5-7 years of experience in health care risk management and/or claims. Prior hospital and/or physician practice related experience strongly preferred. Clinical experience a plus.
Knowledge/Skills/Abilities - High ethical standards. Demonstrated analytical and organizational skills. Ability to clearly present complex concepts verbally and in writing to all levels of the Health System, and externally. Ability to work independently and prioritize multiple projects. Ability to research, analyze and interpret regulatory requirements and apply them to policy, procedure and practice. Knowledge of MS Office applications and healthcare information systems.
Internal Number: DIREC02543
About Meritus Health Inc.
Meritus Medical Center is a state-of-the-art, not-for-profit, community hospital that has cared for patients for more than a century. Accredited by The Joint Commission, Meritus Medical Center invests millions of dollars and resources each year to provide for the health care needs of vulnerable and underserved populations. The hospital’s link to Robinwood Professional Center, a multiservice medical mall, creates a combined one-million-square-foot main campus, the largest medical footprint in the state. A proven provider of expert care, some of Meritus Medical Center’s recent achievements include:
•Magnet® Designation by the American Nurses Credentialing Center or ANCC for excellence in nursing care. Meritus Medical Center has joined the top 8% of hospitals in the country as a Magnet® hospital.
•The Silver Beacon of Excellence award for the critical care unit, recognition from the American Association of Critical-Care Nurses or AACN for exceptional care
•The certified primary stroke center, a recipient of the American Heart Association/American Stroke Association’s Get With the Guidelines® Stroke Gold Plus.