The University of Kansas Hospital - Business Operations Careers

Director - Claims Management & Risk Job

Facility: The University of Kansas Hospital - Main Campus

Department: CLAIMS & INSURANCE

Schedule: Full Time

Shift: Days

Hours: 8 - 5

Work among the best. We are a top 25 employer in the metro area offering a wide array of career opportunities within our organization. We have a leading reputation for patient care, medical education, research, and community service. We value and respect the talented, committed, and diverse people who make up our health system; they are our most important strength. The health system offers very competitive wages and an outstanding benefit package.

We currently have an opening for Director of UKP Management Claims and Risk

Responsibilities:

Actively participate in root cause analysis meetings as appropriate to review adverse/sentinel event occurrences and near misses that affect, or may affect or involve, any UKP practitioner.

Participate as member of facility or enterprise crisis management teams pursuant to applicable policies.

Collaborate with University of Kansas Health System ("UKHS") medical staff and medical staff leadership to facilitate investigations, assuring all relevant privileges and protections are triggered and preserved.

Counsel practitioners on process and procedures involved with root cause analysis meetings and investigations, providing support as needed.

Review peer review requests and prepare documents for peer review committees.

Assist practitioners with answering questions on licensure and credentialing applications which includes obtaining necessary documents to accompany the application.

Review discharge from practice letters and discuss and evaluate patients that physicians wish to discharge from their practice.

Collaborate with UKP Human Resources to ensure that HR-related issues and findings are effectively documented and necessary corrective actions are taken.

Immediately notify the Health Care Stabilization Fund ("HCSF") of any claims, demands, or lawsuits or issues likely to result in a claim.

Ensure compliance with various codes, laws, rules and regulations concerning patient care (including those mandated by state and federal agencies), incident reporting and investigation activities.

Review and track incidents and cases identified as potential risk issues.

Review and investigate patient/family complaints, patient demand letters, and incident reports; in collaboration with UKHS and UKP, make recommendations to HCSF if requested regarding disposition of complaints and demands.

Assist physicians with response to patient complaints in coordination with the Risk Management and Patient Relations departments.

Collaborate with Regulatory, Clinical Risk Management and other relevant departments to facilitate compliance with Medicaid/Medicare and other federal and state regulations

Request bill holds; make recommendations for waiver of bills; and attend bill-hold meetings.

Participate in compliance oversight; monitor accreditation and regulatory inspections, surveys, and visits.

When necessary or prudent, request counsel for practitioners and as requested by the HCSF, serve as the liaison to attorneys for requests to interview UKP practitioners, obtain depositions for subsequent treating practitioners, and identify and prepare UKP practitioner witnesses.

As requested by the HCSF, assist with preparation for trial, including sending litigation holds, and assisting with discovery.

Request medical records and copies of bills for patient complaints, demands, and claims.

Provide independent, unbiased and discrete assistance to UKP practitioners regarding potential claims at the pre-claim stage; and investigate cases identified as potential risk issues, with a goal of avoiding or minimizing the UKP practitioner's professional liability and harm to professional reputation.

As requested by the HCSF, attend mediations and trials on behalf of UKP and UKP practitioners

Collaborate with Legal and Compliance departments to facilitate responses, including corrective actions to any Statement of Deficiency involving the OIG, OCR, KDHE, FDA, FBI, CMS and other regulatory and/or enforcement agencies

As request by the HCSF, participate with Senior Leadership and legal counsel in formulating defense strategies.

Assist district attorney or other prosecutor in identifying witnesses for criminal, child custody, guardianship, and child in need of care cases; facilitate practitioner attendance

Trend and facilitate reports to the Quality Council and the UKP Board regarding any fines, sanctions and/or deficiencies levied by or through the OIG, OCR, KDHE, FDA, FBI, CMS and other regulatory and/or enforcement agencies

Assist practitioners with responses to licensure board complaints; insurance grievances; and insurance peer review issues

  • Respond to requests for information and subpoenas from various agencies.
  • Review proposed UKP policies, programs, agreements and relationships from a risk perspective, in order to identify and minimize risk where appropriate.

Review collected data to identify trends regarding accidents, incidents, claims and/or occurrences, preparing analysis and reports, and recommending corrective action to UKP leadership and Board of Directors.

  • Ensure that risks are minimized by following up and acting on all regulatory and/or survey report recommendations and identified deficiencies.
  • Oversight for maintenance of physician certificates of coverage and verification of insurance and claims history.

Obtain part-time affidavits for full-time faculty for HCSF coverage.

Requirements:

High School Diploma or equivalent required

Bachelor's Degree in Health Care Administration, Business, Finance required

MHA, MSN, or JD preferred

5-7 years of experience as a claims manager in a health care environment required

5-7 years of experience in claims management for integrated health system preferred

Knowledge of regulatory codes, legal requirements and health care law issues impacting enterprise and practitioner risk.

Effective presentation skills; articulate, persuasive communicator

Self-motivated with the ability to work independently; requires little supervision

Ability to manage/handle stress while under pressure from many involved parties

Ability to interface with a variety of professionals, including Board members, medical staff and senior leadership, attorneys, accountants, actuaries, brokers, underwriters, etc.

Demonstrated skills in strategic planning, implementing and evaluating programs

Knowledge of clinical and non-clinical loss control and claims administration

Ability to prioritize tasks and see the big picture

Ability to delegate and know when to ask for assistance

Demonstrated ability to offer creative, innovative solutions to prevent or reduce risk

Ability to manage information and advice in a confidential manner

Maintain depth of knowledge of applicable legal and regulatory requirements.

*** If selected to move forward in the hiring process, you will receive an email invitation to schedule your interview for this position. Please continue to check your email after you have submitted your complete application online.

To check the status of your application, please login to the Careers page and select the Application History tab ***

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