HCA Physician Services Group
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Manager Risk Management
at HCA Physician Services Group
The risk manager is responsible forthe facility's risk management activities, which includes, but may not belimited to a general knowledge of facility insurance programs, managing claimsagainst the facility, interfacing with defense legal counsel, administering therisk management program on a day-to-day basis, managing and analyzing riskmanagement data, and conducting risk management educational programs, complyingwith risk management related standards by JCAHO and other accrediting andregulatory agencies with the objective of enhancing patient safety, promoting patientsafety, quality care, and minimizing loss to protect the assets of thefacility. This individual participates in formulating policy and/ororganizational changes, but must seek advice and approval from higherauthority. Risk management may be one of several areas of responsibility forthis individual.
Participatesin providing patient specific care standards as directed, and follows serviceexcellence standards to ensure high levels of patient satisfaction.
- The level one risk manager has specific responsibilities regarding gathering and analyzing data and preparing reports to management and outside agencies as required, which may be subject to final approval by facility management. Responsible for keeping management advised of developments in professional liability, entailing ongoing review of applicable literature. May recommend budget items to management.
- Specific Activities
o Develops,coordinates, and administers facility-wide systems for risk identification,investigation, and reduction; maintains a network of informational sources andexperts; performs risk surveys and inspects patient care areas; reviewsfacility and to assess loss potential.
o Participateson committees directed towards promoting patient safety issues.
o Maintainsrisk management statistics and files in compliance with TJC and state andfederal agencies; promotes maximum confidentiality by limiting access of suchinformation. Also strives to verify that the following information is accurate,available, and secure: includes medical records, patient billing records,policies and procedures, incident reports, medical examiner's reports (ifavailable), as well as any other data pertinent to a particular claim.
o Collects,evaluates, and distributes relevant data concerning patient injuries: aggregatedata summaries, monthly trend analyses of incidents, claims profiles, andworkers' compensation trends; provides aggregate analysis of risk data;maintains statistical trending of losses and other risk management data.
o Informsdirectors of service and department heads regarding occurrences, issues,findings, and risk management suggestions; provides feedback to directors atall levels in the effort to eliminate risks; assists clinical chairs anddepartment heads in designing risk management programs within theirdepartments.
o Workswith legal counsel to coordinate the investigation, processing, and defense ofclaims against the facility; records, collects, documents, maintains, andprovides to defense attorneys any requested information and documents necessaryto prepare testimony in pending litigation.
o Respondsto professional liability and facility liability questions posed by physicians,nurses, and other personnel.
o May haveon-call responsibility.
o Advisessecurity on procedures to reduce the frequency and/or minimize the severity ofproperty loss or assets.
o Providesassistance to departments in complying with Joint Commission or otheraccrediting agencies, regarding risk management related standards.
o Recommendsappropriate revisions to new or existing policies and procedures to reduce thefrequency of future occurrences; recommends ways to minimize risks throughsystem changes; reviews and revises facility policies as appropriate tomaintain adherence to current standards and requirements.
LOSS PREVENTION/PATIENT SAFETY
- The level one risk manager is responsible for development of loss prevention programs that may include but not limited to patient safety issues. Periodic in-services and routine orientation may be conducted for facility employees/medical staff regarding health care risk management and related subjects. This position may utilize outside speakers and faculty for such programs, subject to the approval of management, and may coordinate such efforts with the facility's education department.
- Specific Activities
o Proactiveanalysis of patient safety and medical errors processes.
o Participatesin the process of disclosure for medical errors.
o Participatesin root cause analysis investigation and reporting of adverse drug events andsentinel events to the appropriate parties.
o Maintainsawareness of legislative and regulatory activities related to health care riskmanagement.
o Complieswith various codes, laws, rules, and regulations concerning patient care,including those mandated by state and federal agencies, incident reporting.Includes investigation activities of federal, state and local enforcementauthorities.
o Providesin-service training to medical center personnel to enhance their awareness oftheir role in reducing liability exposures.
o Disseminatesinformation on claim patterns and risk control, as well as legislative andregulatory changes.
o Maintainsa risk management education calendar.
o Takessteps to ascertain that risks are minimized through follow-up and actions onall regulatory/insurance survey report recommendations/deficiencies.
o Receivesand investigates reports of product problems to determine appropriate response(in-house recalls, independent evaluations, etc.).
o Participateson select committees related to provision of patient care.
o Receivesincident reports and other information regarding untoward occurrences in thefacility, such as quality assurance outliers or variations, and collates suchinformation systematically to permit analysis pursuant to risk managementpolicy and procedure.
o Reviewscollated data to identify trends regarding accidents or occurrences, andrecommends corrective action to management, if appropriate.
o Preparesreports to management regarding trends/patterns and findings. Recommendselectronic data programming initiation and improvement
- The level 1 risk manager receives complaints/claims related to professional and general liability and transmits that information to the appropriate department manager, administrative representative, patient ombudsman, insurance carrier or legal counsel. At the request of management, legal counsel, or the adjuster, participates in responding to the complaint or claim to obtain information and facilitate settlement at an early stage. Works in coordination with patient ombudsman or acts as same to resolve complaints before they develop into professional/general liability claims.
- Specific Activities
- Designs, implements, and maintains a direct referral system for staff to report unexpected events and potential claims against the facility through such input sources as medical records, business office, patient advocate, nursing, medical staff, quality improvement, etc.
o Investigatesand analyzes actual and potential risks in the institution; assesses liabilityand probability of legal action for potential notification of insurancecarriers.
o Directlyrefers to administration those incidents with claims potential; reports tohigher authority any serious event involving actual or potential injury topatients, visitors, or employees.
o Assistsin processing summons and complaints served on present and previous employees;assists defendants in completing necessary documents.
o Withdirector of patient representatives, reviews patient complaints that may be thesource of potential legal action; discusses and offers solutions when possibleto resolve with patient and/or family any grievances perceived as potentialliability claims.
o Participatesin evaluation of claims for settlement; negotiates settlement of small claimswithin administrative authority; advises collection department of appropriateaction for unpaid accounts involved in litigation; approves payment for orreplacement of lost property after evaluating claim.
o Reviewsnational and local claims data; analyzes prior claims, lawsuits, and complaintsagainst the facility.
- The level 1 risk manager has general knowledge of, and is familiar with, the facility's insurance coverage against liability and casualty loss, including self-insurance funding and budgeting for payment of deductibles, risk retention, and coinsurance. Usually participates in management reviews of insurance coverage and related issues. May prepare summaries of the facility's insurance program for management and staff.
- Specific Activities
o Notifiesthe liability insurance carrier of all actual and potential claims, includingprimary and excess carriers as necessary.
o Mayverify with the Medical Staff Services Coordinator that each independentpractitioner provides proof of adequate professional liability insurance at thetime of initial credentialing and at reappointment.
o May actas liaison with the insurance carrier; completes insurance applications andresponds to surveys; prepares materials necessary for renewal of primary andexcess insurance policies.
o Providesinsurance information to outside agencies; assists in compliance with stateinsurance reporting requirements.
· Employee's conduct must reflect the Company'svalues and a commitment to the Code of Conduct ethics and compliance program.
· Employee reflects SDH Service Excellencestandards in every interaction.
· Other duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES:
Required: Strongwritten and oral communications skills, presentation skills, team player,ability to influence change without direct authority, and negotiation skills.
Mustbe able to demonstrate understanding of national patient safety initiatives bystrict compliance to all safety protocols and procedures as required by bothHCA and St. David's North Austin Medical Center.
Preferred: Computer skills, previous experience inapplicable field
EDUCATION AND EXPERIENCE:
Required: Graduateof accredited applicable school with degree focus in Risk Management or relatedfield; graduate of accredited nursing program Associate's level or higherdegree, [if RN] enrolled in an Alternate Entry MSN program or higher leveleducation.
Preferred: Bachelor'sDegree in Nursing from Accredited University; experience in Risk Management preferred
LICENSES AND CERTIFICATES:
Required: CurrentTexas RN License or aCompact RN license from a NCLA Compact State. New hires have 90 daysfrom start date to obtain Texas RN License.
Preferred: BLS certification as per SDH policy; ACLScertification as per SDH policy.
Reportsto: Directorof Risk Management