Reporting to the Senior Vice President, Transformation, initiates, coordinates, and manages all investigational and evaluation activities associated with professional and general liability occurrences and claim pre-litigation files. Negotiates resolution with authority from the Chief Transformation Officer. Provide basic and complex preventive risk management assessment of processes, procedures, and programs, including in-service education, consultation, liaison activities, and on-call emergency assistance to providers. The Risk Manager has the authority and responsibility to administer the risk management program for the facility and related entities. The Risk Manager is responsible for developing and implementing appropriate measures to identify and minimize the risk of injury to patients, visitors and staff, and to minimize loss or damage to property.
Investigates and analyzes potential and actual professional liability and general liability exposures in the Health System; evaluate the extent and elements of exposure and recommend appropriate actions for risk mitigation.
Investigates, evaluates and documents pre-litigation occurrences and claims. Recommend resolution, and complete negotiation of resolution within authority granted by Chief Transformation Officer or CEO. Complete notifications and financial recommendations needed for compliance with tracking and insurer requirements, including insurance carrier notifications, reserve recommendations, and any federal, state, or entity reporting requirements (including AHCA, NPDataBank, etc.) as necessary.
Reviews code and investigates occurrence reports; recommends corrective actions based on individual reports or trends. Provide quality assurance and peer review referrals as appropriate.
Provides in-service education on risk management topics, both standard basic education and complex focused topics as needed and/or requested.
Provides on-call assistance for emergent/urgent risk management issues to all PMC staff as needed. On-call duties are assigned on a rotation basis when possible.
Prepares reports and analyses setting forth progress, adverse trends and appropriate recommendations or conclusions.
Participates on various PMC and entity committees as required. Perform other related duties incidental to the work described herein.
Develops and enhances existing risk management programs to be consistent with the established philosophies and procedures of the PMC Risk Management function.
Directs and assures efficient and effective occurrence review and claim file management. Set and reinforce investigation and response standards. Identify and resolve staff and system issues, which impede compliance with departmental standards. Respond promptly to client and claimant concerns with regard to response time or investigation time frame. Report exposures identified through incident and claims investigations to the Chief Transformation Officer and the Vice President of Acute Care Services.
Assures departmental support and participation in the Patient Safety process. Evaluate individual files and trend data for issues for referral to the Patient Safety Officer and compliance with regulatory requirements. Conduct departmental performance improvement as required. Provide risk management data and support to the facility patient safety and quality improvement processes as needed.
Assures compliance with the information reporting needs of Florida Medical Insurance and the risk management standards required by the reinsurance market.
Provides risk management information on medical and allied health staff to medical staff services for use in the credentialing process.
Determines and recommends appropriate reserve levels for claim files; ensure adequate financial coverage to support resolution of claims.
Authorizes financial settlement of claims within limits prescribed by PMC Counsel and Florida Medical Insurance.
Attends national and local conferences to keep abreast of national trends in determining institutional priorities.
Plans, coordinates and supervises the activities of Risk Management staff.
Bachelor's degree in business administration, public policy, hospital administration or a related field to acquire appropriate analytical, communicative and organizational skills. A Bachelor's degree in a clinical field (e.g. nursing, physician's associate) may be substituted if supplemented by additional courses or training in business or a related field (at least one year).
Work requires a minimum of four years experience in one or more of the following fields: patient care, public policy, health care administration, business administration, legal support or insurance/claims investigation and settlement.
Graduate education beyond the bachelor's degree in hospital administration, business administration or a related field may be substituted for the required experiencea1:1basis. Or an equivalent combination of education and job-related work experience.
Florida Risk Manager License Required. Associate in Risk Management or Certified Professional in Healthcare Risk Management preferred.
Parrish Medical Center (PMC), a Parrish Healthcare integrated care partner, is located at 951 N. Washington Ave., Titusville, Florida. The 210-bed, not-for-profit acute care public medical center has been serving Brevard County for nearly 60 years. PMC is the first in the nation to be Integrated Care certified by The Joint Commission and is nationally recognized as One of America’s Finest Healing ...Environments®. PMC has earned top rankings on The SafeCare Group’s Top 100 SafeCare Hospitals® since 2015. The Joint Commission consistently named PMC as a Top Performer on Key Quality Measures, recognizing PMC for “exemplary performance in using evidence-based clinical processes that are shown to improve care.” The hospital has earned straight “A” safety ratings (since 2012) from The Leapfrog Group, an independent, national not-for-profit organization founded more than a decade ago by the nation’s leading employers and private healthcare experts. In 2014, Consumer Reports recognized PMC as Florida’s safest hospital. PMC, as compared to other U.S. hospitals, maintains top-tier national rankings for clinical outcomes, safety and patients’ experiences. For more information, visit www.parrishmed.com.