Description The Director of Risk Management is accountable and responsible for the management and direction of the risk management and loss prevention program, under the general direction of the System Vice President Risk Management & System Privacy Officer. Essential Duties and Responsibilities of the Director of Risk:Direct, administer, and promote the enterprise risk management program. Advise senior management of potential risk exposures and strategies to minimize them. Manage day-to-day risk management program operations.
Act as a liaison and coordinate with and serve as a resource for local leadership and clinical staff of the member facility with respect to risk management activities. Collaborate with staff to identify, monitor, and report on risk trends.
Oversee claims management for cases affiliated with physician practice groups, and post-acute facility, Monitors, investigates, and oversees all claims, potential claims, and licensing board complaints.
Work closely with defense counsel and staff in all aspects of the captive claims management operations. Ensure timely investigations and claim reports by the TPA. Monitor case activity of defense counsel on professional liability and general liability claims, including attendance at discover meetings, depositions, trial, and other relevant meetings.
Assist affiliated physician practice groups, and post-acute facility with and serve as a resource regarding health care licensure, accreditation, HIPAA, other regulatory standards, and ensure compliance.
Serve as a resource for affiliated physician practice groups, and post-acute facility regarding clinical healthcare risk management issues.
Data collection, management, and analysis related to risk management and claims, and prepare and present reports.
Collaborate with the Patient Relations Coordinator to address patient complaints and grievances.
Collaborate with System Director of Compliance to address/ensure compliance
Qualifications for Director of Risk Management:A Bachelor's degree is required (Master's degree or JD preferred) in a health care field.
Minimum of five to six years experience in risk management/loss prevention.
Three to five years in management/supervisory position(s).
Patient care, legal or claims supervisory, computer and quality management experience is preferred.
Incumbent will be self-directed and require little oversight in performance of duties, which include financial, human resource, technical, quality management and team building concepts.
Requires excellent interpersonal skills, analytical and conceptual thinking ability, team building ability with an emphasis on performance and achievement.
Experience with the management of healthcare-related liability claims.
Knowledge of insurance and loss control.
Associate in Risk Management (ARM) and Professional Healthcare Risk Management (CPHRM) certifications strongly desired.
Requirements Assess Risk, Compliance Risk, Conduct Risk Assessments, Medicare Risk Adjustment, Potential Risk, Analyze Trends, Identifying Trends, Perform Trend Analysis, Medical Claims, Insurance Claims, Litigation Processes, Liability, Data Collection, Data Analysis, Affordable Care Act (ACA) Reporting, Policies & Procedures, Policies And Procedure, HealthCare Analytics, Healthcare Administration, HealthCare Claim, HealthCare Common Procedure, HealthCare Environment, HealthCare Industry, HealthCare Organizations, HealthCare System, Data Analytics, Analytics, Loss Control