The Market Director of Risk & Insurance (“Director”) helps formulate, support and communicates the goals of the Mercy Health Risk and Insurance Services Department within the Market, and shares accountability for achieving program goals and objectives. The Director leads, all aspects of risk management for the Market. The Director is responsible for a Market- enterprise wide risk management program for acute and non-acute care centers, physician practices, and all ancillary business entities when Mercy Health is the majority owner. Specific Risk Management responsibilities include but are not be limited to:
Administer the enterprise risk management program on a day-to-day basis;
manage and analyze risk management data;
identify and minimize loss exposures in order to protect the assets of the Market; maintain a general knowledge of the Market’s insurance programs;
conduct risk management educational programs;
comply with regulatory and accreditation standards;
manage retained losses through standardized processes;
work in conjunction with Mercy Health Claims Department and outside defense counsel in the defense of all claims.
Directs the risk management program for the Market; Supervises risk management and insurance personnel throughout the Market; serves as a subject matter expert for the Market and Home Office initiatives and Collaboratives. Works under the direction of the CEO regarding the use of loss control data for accountability for the Market and the System.
Has full responsibility for Market operations of the risk management program including an enterprise approach to exposures.
Directs loss control/loss prevention activities based on the Market risk profile and reports results to the CEO on a regular basis.
Supervises the statistical trending of Market-specific risk exposures and losses and analyzes patterns.
Collaborates with Mercy Health Home Office Risk Management, Patient Safety and Legal departments on various safety and risk mitigation initiatives.
Prepares and monitors annual budgets to achieve departmental goals and objectives.
Identifies and communicates legislative activities and litigation trends to executive leadership.
Develops and implements departmental and facility policies and procedures that affect liability exposures.
Represents Market and Home Office in national and state professional societies.
The Director organizes and manages the Market wide loss prevention strategies and initiatives. These strategies include proactive risk activities such as risk assessments, educational programs, consultations and ensuring compliance with the multiple laws and regulations affecting patients, visitors, employees and the community we serve.
Designs and implements risk management surveys and studies.
Produces evidence based strategies and industry standards to assist in strategic planning.
Participates in the event management process including initiating and participating in the Event Investigation Team; coaching leadership and physicians in the apology and disclosure process; attends the Root Cause Analysis; may assist with the early liability review process.
Adheres to all Mercy Health policies regarding serious reportable events and sentinel events.
Participates in/provides guidance regarding medical staff credentialing and peer review referrals.
Contributes in establishing loss prevention initiatives related to non-clinical risk reduction and mitigation techniques by implementing commercial insurer’s recommendations for loss control.
Complies with various codes, laws, rules and regulations concerning patient care, including those mandated by state and federal agencies, incident reporting, also includes investigative activities with federal, state and local enforcement authorities.
Plans, develops, and presents educational material to administration, the medical staff, nursing personnel, and other department personnel on topics related to risk management.
Acts as a consultant and answers medical/legal inquiries of physicians, nurses and administrators regarding emergent patient care issues, insurance & claim questions.
Participate in Patient Safety WalkRounds, Collaboratives, and other patient safety activities.
Oversees the effective management of SafeCARE reporting and documentation.
Takes “On call” responsibility related to risk management issues and adverse events as scheduled.
The Director controls the initial risk management investigation and if a claim is expected or received works actively with the Home Office Claims Managers and external defense counsel in preparing a defense. The Director ensures systems are in place to have all potential and asserted clinical and non-clinical claims reported to Home Office Claims Managers in a timely fashion.
The Director acts as a Market representative at legal proceedings.
Acts a signatory on interrogatories and requests for production of documents.
Apprises Senior Leadership of overall claim experience on a regular basis and high exposure events as they become known. Provides a report, at least annually, to the Board regarding litigation and settlements for the Market and any trends identified in the Market or external to the Market as well as mitigation plans to address trends.
Approves settlements within his/her authority.
The Director maintains a general knowledge of, and is familiar with, the facility’s coverage for professional liability, property and casualty loss, including CHP Insurance Ltd, the, risk insured retention, and coinsurance.
Participates in the Market’s insurance programs by ensuring exposure data is maintained to facilitate renewal of the CHP centralized insurance program.
Communicate to the Home Office any new exposures to avoid coverage gaps.
Serves as subject matter experts to Market leaders with questions regarding risk financing.
Acts as a consultant to the Medical Staff office regarding issues related to adequacy of medical staff members’ insurance carriers and limits.
Participates on the Underwriting Council for physician candidates in the Market.
KNOWLEGDGE, SKILLS & ABILITIES
Bachelor’s degree in Healthcare related field or Business required. Masters Degree preferred.
Certification in Risk Management (CPHRM or ARM) required and fellowship or other advanced training in patient safety preferred.
Demonstrated understanding of the risk management process, principles and practices essential.
Excellent report writing and public presentation skills.
5 years of acute care healthcare Risk Management operational experience required.
Familiarity with Professional Liability Claims process and/ Risk Financing/Insurance experience preferred.
Excellent interpersonal relations and communications skills (verbal, written, and listening skills). Ability to build collaborative relationships with internal and external customers. Able to establish excellent rapport with physicians and other health care executives; must have a diplomatic and consultative approach.
Ability to conduct risk assessments, and pro-actively identify risk exposures.
Ability to manage, aggregate and analyze data.
Attention to detail and highly effective time management skills. Ability to develop and lead a highly effective and productive team.
Expertise with clinical performance improvement using traditional and evolving quality improvement tools and techniques (e.g., RCA, PDSA/Rapid Cycle Improvement, Patient Safety WalkRounds, FMEA, etc.).
Action-oriented, shows initiative, enthusiasm and motivation toward the principles of patient and resident safety. Demonstrated ability to work independently without day-to-day supervision.
Familiar with adverse event reduction methodologies and their successful, measurable applications.
Strong organizational and project management skills to support implementation of system-wide risk initiatives.
Excellent understanding of various regulatory and accrediting bodies and laws affecting patient care.
The ability and willingness to identify with, share in and have commitment to the philosophy, mission, values and vision of our Sponsors and Catholic Health Partners
Risk and Insurance Services is a professional service program established for the purpose of identifying, preventing, responding to and recovering from events which may adversely affect our operations, financial security, as well as our patients, visitors, employees, medical staff and volunteers.
Risk and Insurance Services has three primary functions which include: 1-Managing the self insuran...ce and commercial insurance plans through partnership with the markets, 2-Respectful claims management, 3-Pro-active risk management to include the minimization of harm to our patients, visitors, employees and the organization.
Services provided include, but are not limited to, the following: Consultations regarding our primary functions, education sessions for clinical and non-clinical topics, just-in-time training for apology and disclosure, support for new initiatives, Root Cause Analysis participation, Risk assessments