Reports directly to the VP Legal Affairs & General Counsel. Collaborates with the System Director of Risk Management & Patient Safety. May take direction from CEOs of Munson Healthcare entities and affiliate facilities.
POPULATIONS SERVED COMPETENCIES, INCLUDING AGE OF PATIENTS SERVED; No direct clinical contact with patients
Supports the Mission, Vision and Values of Munson Healthcare
Embraces and supports the Performance Improvement philosophy of Munson Healthcare.
Promotes personal and patient safety.
Uses effective customer service/interpersonal skills at all times.
Maintains the Munson Healthcare system for managing professional and general liability claims for all MHC System entities. Follows established Claims Management policy and procedures.
Assists the System Director of Risk Management & Patient Safety in analysis of claims for risk management and quality improvement opportunities. Provides recommendations to management that assist in averting future claims.
Collaborates with Risk Management, Patient Relations, Patient Safety, Clinical Quality, Health Information Management, Accreditation, Medical Staff Services, Safety & Security, and others, as required to effectively manage claim/potential claims.
Evaluates the litigation potential of incidents and adverse outcomes occurring within MHC hospitals, clinics, offices, and properties.
Complies with insurance company (Professional Liability, General Liability, Excess Carrier, , Auto Carrier, others) policy and agreements for reporting claims and claim management.
Creates and maintains the primary file for each potential and asserted professional or general liability claim. Is administrator of the computerized software application for claims which interfaces with the patient safety event and the patient relations applications.
Accesses, obtains, reviews, and summarizes, medical and billing records and interviews providers and other witnesses in preparation for insurance company and defense proceedings.
Actively preserves the confidentiality of claims files and patient and corporate protected information. Knows and coaches others on compliance with HIPAA, Patient Safety Evaluation System, Patient Safety Work Product, peer review, attorney/client work product, and other applicable regulations and laws.
Works proactively to develop and manage strong relationships with providers, insurance company consultants, attorneys, co-defendants/insureds. Coordinates the scheduling of depositions and trial testimony with defense firm staff.
Supports, coaches, guides, and educates staff, and physicians/providers, through the litigation process. Coordinates staff participation with managers.
Duties delegated to the Claims Manager by VPLA include:
May accept service of legal documents on behalf of MHC. Serves as liaison with legal and human resource departments for law enforcement activities and subpoena delivery.
Serves as the primary liaison with insurance company claims consultants and defense counsel on all issues relevant to claims management.
Communicates resolution decisions and authorization for settlement collaboratively with claims consultants, defense counsel, and other involved parties.
Has access to, and accountability to preserve, information/data within peer review, quality improvement, and PSWP systems.
Represents MHC entities at evaluation and defense strategy meetings with insurance claims consultants and defense counsel.
Prepares data and reports for presentation to Board and medical staff committees.
Travels regularly via automobile to all MHC entities to attend investigatory meetings, depositions, mediations, and court hearings.
Prepares and provides oral and written reports to various internal audiences (Boards, Committees, etc).
Performs other duties and responsibilities as assigned.
Bachelor’s Degree required; degree in health care field or legal field preferred. Experience with insurance programs and healthcare risk management / compliance preferred. Working knowledge of litigation process/procedures preferred. Combined professional liability claims and casualty claims management experience preferred.
Excellent interpersonal skills required. Demonstrated ability to communicate effectively and build positive relationships with physicians, nurses, other health care professionals, insurance representatives and attorneys. High degree of accuracy and mental awareness. Ability to analyze complex situations and make accurate independent decisions.
Knowledge and ability to perform data processing / data basing and word processing computer tasks required. Working knowledge of medical terminology is preferred. Comfortable preparing and giving presentations to internal audiences.
Able to work effectively and efficiently under tight deadlines, high volumes with multiple interruptions.
Internal Number: 002
About Munson Healthcare
Munson Medical Center, a 391-bed regional referral center and Level II Trauma Center, located in beautiful Traverse City, Michigan.