Category:

Professional

City:

Jackson

State:

Tennessee

Shift:

0 - Day (United States of America)

Job Description Summary:

Patient Safety Risk Managers are responsible for assisting the Director of Clinical Risk Management and supporting the system’s risk management program, including utilization of high-level decision-making in the identification, evaluation, and minimization of risk in the organization while promoting patient safety through optimal process implementation and reporting data on risk opportunities to other stakeholders.

ESSENTIAL JOB FUNCTIONS:

Investigations:

• Assist with the investigation of claims, occurrences and events, utilizing the appropriate analysis level for the severity of the matter.
• Reviews and analyzes patient records, including those giving rise to pre-suit notices, to determine the appropriate standard of care and prepares case summaries of claims, identifying and outlining potential standard of care concerns.
• Supports process of root cause analyses in the event of a sentinel event or other events as determined by WTH protocols. Coordinates review of medical information, interviews of individuals as identified, performs cause and effect analysis and coordinates review and follow-up for all incidents identified.
• Assists with communication and documentation of investigative information related to errors or serious events in accordance with legal requirements and/or accreditation standards, and assists with corrective action plans as requested.

Risk Reduction and Prevention:

• Assists Director and healthcare system in identifying and correcting environmental conditions and work practices that could result in injuries or claims.
• Communicate with and obtain information from departments and professional staff in sensitive situations involving actual or potential claims.
• Facilitate loss prevention programs in coordination with system needs and external agencies as appropriate.

Occurrence and Other Reporting:

• Utilize comprehensive occurrence reporting system to receive, investigate, and evaluate variances or occurrences involving potential claims, as well as programs to encourage and reward occurrence reporting.
• Develop and maintain positive working relationships with departments and staff to encourage a timely and accurate flow of information.
• In coordination with other departments, prepares or assists in preparing reports of events as required by law or accreditation agencies.
• Monitor, manage and or assist with Federal, State, and regulatory reporting requirements in coordination with other departments.
• Manage and make decisions regarding the preparation of reports required by various agencies and hospital administration.

Claims Management:

• Reviews patient complaints which may result in legal action and prepares case summaries outlining potential standard of care issues to assist in the determination of next steps for claims.
• Works with billing, legal, and compliance in determining and facilitating billing waivers/write offs.
• Works with the Legal Department to coordinate the investigation and defense of claims, including collection of information needed to respond to subpoenas, court orders, and discovery requests. 

JOB SPECIFICATIONS:

EDUCATION:

• High school diploma required. 
• Bachelor's degree in a health-related field, or current licensure as Registered Nurse required, with electronic medical record review or legal chart review experience preferred

LICENSURE, REGISTRATION, CERTIFICATION:

• Not required, but ASCPHRM (Certified Professional in Healthcare Risk Management) Certification preferred
• Valid Driver’s License Required – travel to other West Tennessee Healthcare facilities in the employee’s personal vehicle will be required

EXPERIENCE:

• Experience in risk management, quality improvement; patient care; medical case management; legal support; or conducting investigations and documenting claims preferred
• Experience with patient/family relations preferred

KNOWLEDGE, SKILLS AND ABILITIES:

• Ability to develop rapport and effectively interview employees, visitors, patients, or medical staff.
• Organization, analytical and problem solving skills to investigate and document claims.
• Ability to implement risk management reporting processes.
• Excellent interpersonal and communication skills.
• Professional appearance and demeanor.
• Basic knowledge of state and federal rules, regulations and accreditation standards applicable to hospital systems.
• Ability to effectively teach occurrence reporting and risk management principles to staff to facilitate occurrence reporting and risk management.
• Ability to efficiently manage multiple projects and deadlines.
• Basic knowledge of software programs used in the Risk Management and WTH environment, including Word, Excel, PowerPoint, and Outlook.
• Fluency in the English language, ability to read, spell, and write the English language, and to perform mathematical calculations.
• Knowledge and understanding of the dynamics of a large healthcare organization.

NONDISCRIMINATION NOTICE STATEMENT

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, disability, religion, national origin, gender, gender identity, gender expression, marital status, sexual orientation, age, protected veteran status, or any other characteristic protected by law.