Responsible for managing the day-to-day activities of assigned market(s)Risk Management Program including, but not limited to, development, evaluation, and management of all aspects of the Program. Works in collaboration with the market operations leadership, the market quality management team, and the Office of the Chief Medical Officer/ Director (OCMO/D) to identify and mitigate risk; empower identification of actual and potential risk, reporting and mitigation; proactively identify and manage risks to improve patient care.
Provides excellent service to all customers, meeting or exceeding their expectations, to ensure continuous improvement of customer focused environment..
Demonstrates professionalism, courtesy, compassion and respect in communications with leadership, teammates, vendors and patients.
Develops and implements Risk Management policies and procedures.
Collaborates with market operations in the identification and resolution of potential risks related to systems, processes and clinical issues.
Develops/implements, coordinates, and administers market-wide systems for risk identification, investigation, loss prevention, loss reduction and risk mitigation; performs risk surveys.
Develops annual risk goals
Evaluates effectiveness of risk management program.
Maintains awareness of legislative and regulatory activities related to healthcare risk management; maintains a network of informational/knowledge sources and experts.
Collaborates with legal counsel, at their direction, to coordinate investigation, processing and defense of claims.
Manages Adverse Occurrence Reporting system and develops reports to identify trends; identifies potentially compensable events.
Investigates and analyzes actual and potential risks, assesses liability and probability of legal action and notifies Claims and Litigation teammates from all sources including patient compliants/grievences
Participates in disclosure of medical errors and Apology Program
Makes recommendations to market leadership regarding necessary interventions to decrease risks to the organization.
Monitors, evaluates, and advises on all high-risk clinical issues.
Familiarizes with and networks with community health agencies/resources that may be utilized in the management of high-risk clinical issues.
Assists teammates in addressing risk questions.
Participates in and supports organizational committees as appropriate
Coordinates and/or performs projects/activities as assigned
Provides supervision and guidance to staff reporting to this position.
Identifies the educational needs of clinicians, clinical staff, and others as indicated. Develops and oversees in-services or workshops.
Consults with outside legal counsels as needed.
Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Performs additional duties as assigned.
Master’s degree from a four-year college and/or a professional certification requiring formal education beyond a four-year college.
JD or an advanced degree in Health Administration, Law or related field preferred.
Over 5 years and up to and including 7 years of experience.
3 years of management experience in a medical group/IPA or HMO setting.
KNOWLEDGE, SKILLS, ABILITIES:
Excellent verbal and written communication skills.
DaVita Medical Group manages and operates medical groups and affiliated physician networks in California, Nevada, New Mexico, Florida, Colorado and Washington in its pursuit to deliver excellent-quality health care in a dignified and compassionate manner. As of June 30, 2016 DaVita Medical Group (formerly HealthCare Partners) provided integrated care management for approximately 760,000 patients. ...DaVita Medical Group’s leadership development initiatives and social responsibility efforts have been recognized by Fortune, Modern Healthcare, Newsweek and WorldBlu.
We are committed to bringing the benefits of coordinated care to our patients and to taking a leading role in the transformation of the national healthcare delivery system to assure quality, access, and affordable care for all.