This position supports Mercy's philosophy of patient centered care by managing and facilitating a proactive risk management program to protect the individuals and assets of the organization from liability. This includes monitoring and minimizing the risk to patients, staff, and resources of the organization. Collaborates with and acts as a liaison to outside counsel and consultants to represent the hospital and its employees.
Job Specific Duties/Essential Functions
Develops, coordinates, and administers facility-wide systems for risk identification, investigation, and reduction including an organization wide risk assessment; maintains a network of informational sources and experts; proactively performs organizational risk based evaluation based on internal assessment and external benchmarking.
Promotes the occurrence/variance reporting process including trending and reporting of results. Responds to professional liability and facility liability questions posed by physicians, nurses, and other personnel. Acts as the facility’s expert resource in risk management strategies by staying current in risk management and healthcare.
Serves as a liaison and coordinates on-site regulatory (CMS, DIA, IDPH, TJC) complaint inspections and investigations. Leads in the remediation of such complaint visits.
Maintains and coordinates “Risk on Call” schedule. Takes rotating “call” every 3-4 weeks, one week at a time.
Provides leadership in, expertise in, and coordination of organizational self-reporting of safety events. Communicates effectively with management and executive leaders regarding self-reporting, risk related matters, and status updates on risk management activities.
Coordinates compliance to TJC Sentinel Event Alerts, TJC Quick Safety alerts, and TJC complaints. Conducts to completion proactive analyses of patient safety and medical error processes. Facilitates Root cause analyses and makes recommendations for improvement. Communicates organizational “learnings” and process improvement plans appropriately.
Participates in select committees related to the provision of patient care and patient safety.
Plans, develops, and presents educational material to administration, the medical staff, nursing personnel, and other department personnel on topics related to risk management/ patient safety.
Communicates to insurance carrier and/or outside attorney information necessary to prepare testimony in pending litigation. In litigated claims assists insurance carrier and/or outside attorney in accessing facility records and personnel.
Directly refers to administration those incidents with claims potential; reports to higher authority any serious event involving actual or potential injury to patients, visitors, or employees.
With representatives from Patient Relations, reviews patient complaints that may be the source of potential legal actions; discusses and offers solutions when possible to resolve with patient and/or family any grievances perceived as potential liability claims.
Collaborates with clinical staff to disclose and respond justly to adverse events. Works with non-clinical departments (i.e. billing, Finance) to implement customer service recovery strategies, i.e. bill adjustments, write-offs, settlement negotiations within administrative authority.
Maintains and processes all incoming requests for subpoenas and court orders along with handling medical records requests and requests for depositions and expert testimony from the courts, attorneys, and other institutions. Maintains the organization’s Loss-Run Report. Routinely communicates with the CEO regarding insurance claims and costs related to litigation.
Ensure maximum protection from discovery of all claims/potential claims materials.
Coordinate claims investigation and legal defense processes.
Completes insurance and self-insurance forms for members of the medical staff.
Manages the risk management budget.
Knowledge, Skills and Abilities
Experience in healthcare, legal or insurance office setting work desirable. Able to work in a high-volume, complex environment maintaining relationships that foster trust and problem solving approaches. Ability to work self-directed and as part of a multidisciplinary collaborative team. Excellent written, oral, and presentation communication skills. Proven management ability and experience including a thorough understanding of quality improvement (QI) processes, tools, and techniques; quality measurement and reporting; preventive risk management strategies; accrediting bodies’ standards; and state and federal regulations Maintains knowledge in clinical and health care processes Demonstrates strong analytical, critical thinking and communication skills Demonstrates ability to lead and/or facilitate teams and/or projects toward successful achievement of goals Demonstrates knowledge and ability to conduct RCA/Structured Debriefing, and FMEA Professional Experience– Required vs. Preferred 5 years in a Healthcare setting required. Demonstrated healthcare management or performance improvement required. Risk management background preferred.
Education Bachelor's degree is required, Bachelor's degree in a healthcare field is preferred. Licensure, Certification, Registration RN preferred. If a nurse, must be currently licensed to practice in the state of Iowa required. Certification in healthcare risk management preferred.
Reporting Relationships Supervised By: Director, Accreditation and Licensing with a dotted line to the General Counsel for claims management responsibilities.
For more than 100 years, Mercy Medical Center has delivered The Mercy Touch® by partnering the latest technology with compassionate and high quality patient care. Mercy is a 445 licensed-bed regional hospital that is fully accredited. Founded in 1900 by the Sisters of Mercy, today it offers a wide range of patient care services with strengths in cancer care, surgical services, emergency services, ...cardiac care, critical care services, women's services and obstetrics. Mercy is the only hospital in the eastern Iowa Corridor to offer all-private acute patient rooms.