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Job Description

DIrector Risk Management
Date: 09/18/2009
Location: Chicago, IL
Facility:ILLINOIS MASONIC MEDICAL CTR.
DIrector Risk Management - 27842 		Apply Now
Possesses excellent oral and written communication skills, organizational abilities, and statistical analysis. Demonstrates accuracy, thoroughness, and orderliness in performing job duties. Conducts educational programs on Risk Management issues. Exercises sound judgment in difficult circumstances. Bachelors Degree required; Masters degree or post-graduate certification/certificate in healthcare field preferred. Seven years Risk Management experience in the healthcare field required, some experience with a multi-hospital setting preferred. Knowledge of federal and Illinois law.

Job Description:

Directs all aspects of the Risk Management Program at Advocate Hospital Site, hereinafter referred to as 'Hospital.' Oversees the Hospital-wide Risk Management, Claims Management, and Patient Safety functions at the Hospital including the identification and evaluation of areas of risk and liability exposure in the Hospital and the planning and implementation of risk reduction strategies. Manages claims activities including the review and investigation of Patient Safety Events, major occurrences, claims, patient complaints, attorney liens, and lawsuits. Interfaces directly with the Hospital's Administration, Medical Staff, Medical Records, Workers' Compensation, Infection Control, Human Resources, Quality Management, Patient Relations, as well as all clinical and non-clinical departments involved in the health care delivery system. Serves as an active member of the management team in order to design and implement loss prevention strategies and Patient Safety initiatives. Provides Risk Management consultation services and conducts educational programs at the Hospital. Supervises exempt professional staff and non-exempt clerical staff within the Hospital's Risk Management Department.

Accountabilities:
1. Maintains full responsibility for the operation of the Risk Management program, including but not limited to Patient Safety, loss prevention, claims management, and regulatory compliance, in order to improve the quality of patient care, reduce risk, and minimize potential loss. Serves as an internal resource, consultant, and educator for Risk Management, claims management, regulatory compliance, and Patient Safety issues. Directs all aspects of data management, data interpretation, claims management, and the educational components of the Hospital's Risk Management program. Participates as a member of the management team at the Hospital in order to resolve operational challenges. Implements loss prevention strategies and monitors the Hospital's compliance with policies and procedures relating to Risk Management, claims, regulatory compliance, Patient Safety and confidentiality issues. Provides consultation to Hospital departments on new policies and procedures that establish standards and impact Risk Management issues or liability exposures. Establishes relationships with medical staff leadership and the Hospital's department managers to facilitate risk identification. Designs and implements risk identification procedures to avoid, reduce or minimize risk. Monitors compliance with JCAHO Risk Management standards. Serves as a resource for the medical and legal inquiries of physician, nurses, and Hospital administrators regarding patient care issues and loss prevention and/or control. Participates in the resolution of treatment issues, including but not limited to patient decisions made against medical advice (AMA), refusals of treatment, consent issues, surrogate decision-making, privacy concerns, and bioethical issues. Assumes an active role in Failure Mode and Effects Analysis (FMEA) and Root Cause Analysis (RCA) processes and makes recommendations for improvement. Participates in Patient Safety goals by providing data and making recommendations to administration, the medical staff, nursing personnel, and other departments to support Patient Safety initiatives. Displays a proactive approach to Risk Management. Directs loss control and loss prevention activities and reports results to Hospital senior administration. Supervises the statistical trending of losses and analyzes and responds to patterns in that data. Supervises the activities of the Risk Management personnel. Staffs the Hospital's Risk Management and Patient Safety Committees.

2. Directs the Patient Safety Event evaluation process. Ensures the collection of Patient Safety Event data and directs the investigation of those incidents and major occurrences. Convenes interdisciplinary teams to further investigate and analyze of Patient Safety Events and assumes an active role in the process evaluation and system change resulting from that investigation.

3. Partners with legal counsel and claims administrators in the investigation and management of claims. Participates in the negotiation and settlement of non-asserted and asserted claims for management approval. Assists legal counsel in accessing the Hospital records and personnel during the discovery process of cases in litigation. Acts as a Hospital representative during pretrial and trial. Directs and supervises the Risk Management Staff during settlement negotiations of pre-litigation claims. Directs the handling of defense counsel requests and provides assistance to the Claims Administrators and retained defense attorneys. Supervises and coordinates responses to Interrogatories, secures appropriate signatures, and forwards completed documents to retained defense counsel. Negotiates settlement of pre-litigation claims in accordance with the Advocate Claims Management Program. Monitors the process for handling of Attorney Liens and Lawsuits received. Notifies department chairmen of physicians named in lawsuits. Possesses the authority to initiate medical write-offs in order to mitigate potential claims. Oversees the investigation of incidents, accidents, and events that could lead to financial loss, including professional and general liability. Investigates risks involving actual or potential injury to patients and visitors. Collects information necessary to prepare for the defense of claims and lawsuits.

4. Analyzes data received via Patient Safety Event Forms, anonymous reports, telephone referrals, and personal contacts. Identifies trends regarding Patient Safety Events or occurrences. Prepares and presents reports of Risk Management assessment, exposure, intervention, and evaluation to the Hospital's Chief Executive, Claims Manager, Hospital Administration, Governance, and Medical Staff. Makes recommendations to Hospital Administration, Risk Management Committees, and various hospital departments and committees in order to reduce loss exposure and improve Patient Safety. Develops reports containing statistical data in order to identify trends. Analyzes data and makes recommendations for corrective action. Provides monthly incident Summary Reports to Risk Management and Safety Committees. Provides in-service training for all levels of hospital personnel to communicate Risk Management, Patient Safety, and claims management issues. Makes rounds at the Hospital to assess risk, identify Patient Safety issues, and respond to staff concerns. Participates in the orientation of new employees. Participates as member of management team to develop plans to reduce risk Hospital-wide.

5. Plans, organizes, and implements Hospital-wide educational programs and in-services on health care Risk Management, Patient Safety, and related topics for health care practitioners. Develops and presents educational materials to administration, the medical staff, nursing personnel, and other departments on topics related to Risk Management, Patient Safety, and claims management. Institutes annual educational calendars that reflect the Risk Management Department's goals and objectives for education and process improvement within all clinical departments of the hospital. Plans and initiates a hospital-wide Risk Management seminar each year.

6. Collaborates with the administration and staff responsible for the Patient Relations and/or Guest Services programs to ensure that procedures for tracking patient complaints are integrated into the risk-identifying function of the Risk Management Department. Interacts with the members of the interdisciplinary team to ensure a multi-disciplinary response to patient complaints. Collaborates on regular basis with Hospital Administration, Quality Improvement, Guest Services, and clinical departments to provide guidance on handling of patient (customer) complaints, to identify liability exposures, to ensure compliance, and to plan proactive measures to prevent claims. Promotes compliance with: 1. Illinois agencies governing the reporting of specific events 2. Federal acts and regulations 3. Illinois legislation 4. Federal and Illinois laws and regulations governing patient confidentiality 5. Local requirements of reporting 6. Illinois Revised Statues 7. Case Law 8. Departmental Manual (Guidelines and Procedures) 9. Departmental Manual (Guidelines and Procedures) 10. Corporate and Hospital policies and procedures 11. Medical & Nursing Standards of Care 12. JCAHO Risk Management Standards 13. Excess Insurer Requirements

7. Prepares the Hospital's Risk Management departmental goals and objectives. Submits recommendations for the Risk Management department budget. Reviews monthly budget responsibility summary. Monitors expenditures from approved budgets
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