Clinical Risk Manager

Position Summary / Career Interest:

The Clinical Risk Management Department supports and furthers the organization's objective of enhancing safe, compassionate and excellent quality care, while ensuring compliance with regulatory requirements, as well as minimizing loss to the organization. The Clinical Risk Manager promotes safety all with the objective of maintaining staff, visitor and patient safety, enhancing quality care, and minimizing loss to protect the assets of the facility. The Clinical Risk Manager is responsible for risk management activities, which include, but may not be limited to review/analysis of incoming safety event reports; managing and analyzing risk management data, conducting critical analysis of occurrences to determine next steps of requisite follow-up, Root Cause Analysis investigations; facilitating corrective action when warranted; helps ensure compliance with risk management related statutes and other regulatory standards. The Risk Manager will also serve as a risk management resource to all clinical/support departments. Additional related duties include coordinating risk management educational programs; investigating complex clinical patient complaints/ethical questions that are referred to the department; reviewing and formulating policy or organizational changes and recommendations for final approval by senior management; and participating on call rotation for the Department of Risk Management. This position reports to the Senior Director of Regulatory Compliance/Clinical Risk Management.

Responsibilities and Essential Job Functions

• Participate in day-to-day risk management operations, including risk mitigation, investigations, and responding to safety events.
• Develops, coordinates, and administers facility-wide systems for risk identification, investigation, and risk reduction.
• Reviews collected data to identify trends regarding accidents or occurrences, and recommends corrective action to management, if appropriate.
• Informs leaders of events/incidents, issues, findings, and risk management recommendations; provides feedback to leaders at all levels in the effort to eliminate risks.
• Proactive analysis of patient safety and medical errors processes.
• Reviews collected data to identify trends regarding accidents or occurrences, and recommends corrective action to management, if appropriate.
• Prepares reports for leaders regarding trends/patterns and findings.
• Exercise professional judgment and critical thinking to facilitate focused investigation and root cause analysis and the development of appropriate corrective action plans.
• Leads investigations for adverse events and sentinel events.  This includes leading root cause analysis and making recommendations for improvement.
• Prepares risk management and patient safety reports to be submitted to the senior leadership, board, and other appropriate committees.
• Active participation in patient safety activities by providing data to support priorities, clinical risk management expertise, and participating in patient safety projects.
• Supports the patient safety initiatives through direct participation on committees/task forces.
• Acts as resource, internal consultant, and educator for patient safety/risk management issues.
• Develops a consultative relationship with designated service area.
• Complies with various codes, laws, rules and regulations concerning patient care, including those mandated by state and federal agencies, incident reporting, also includes investigative activities with federal, state and local enforcement authorities.
• Designs and implements risk management surveys and studies; conducts surveys studies, and special projects to assist in long-term planning and changes to facility polices and systems that reduce risk and losses.
• Responsible for identifying and communicating regulatory requirements related to risk management.
• Facilitates and assists with disclosure of medical errors and supports providers through the process.
• Assists in resolving treatment issues, including patient decisions made against medical advice (AMA), refusals of treatment, and consent issues.
• Provides assistance to departments in complying with Joint Commission or other accrediting agencies regarding risk management related standards.
• Recommends appropriate revisions to new or existing policies and procedures to reduce the frequency of future occurrences; recommends ways to minimize risk through system changes; reviews and revises facility policies as appropriate to maintain adherence to current standards and requirements.
• Maintains awareness of legislative activities that may affect risk management programs.
• Organizes and manages facility-wide educational programs on healthcare risk management and related subjects for healthcare practitioners.
• Plans, develops, and presents educational material to administration, the medical staff, nursing personnel, and other department personnel on topics related to risk management as they affect personnel.
• Develops and implements educational programs designed to minimize the frequency and reduce the severity of actual and potential safety hazards throughout the facility.
• Maintains a risk management education calendar
• Manages/facilities any of the following activities as assigned:
• Nursing peer review
• Ancillary peer review
• Physician quality review
• Resident quality review
• Collaborates with security and local police on procedures to reduce the frequency and/or minimize the severity of property loss or assets.
• Collaborates with the claims and insurance team regarding actual or potential injury to patients, visitors, and employees; collects information necessary to prepare for the defense of claims.
• Able to skillfully communicate and partner with others via email, telephone and in person.
• Uses time efficiently and effectively. Able to develop and meet project time frames.
• Ability to work effectively from home and onsite.
• Participate in taking risk management call.
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

• Bachelor Degree Nursing
• 5 or more years minimum of at least 5 years of experience as a nurse in a healthcare setting.
• 2 or more years In addition to the clinical experience, must have management experience or leadership role of more than 2 years in a healthcare setting.
• 2 or more years Minimum of 2 years of experience in one or more of the following areas: risk management, quality improvement, health information management, healthcare administration, business administration, legal support, or insurance claims investigation, and settlement.

Preferred Education and Experience

• Master's Degree Master’s Degree in a healthcare related field preferred; JD.
• 5 or more years Minimum of five years’ experience as hospital or health system risk manager or patient safety officer.

Preferred Licensure and Certification

• Certified Professional in Patient Safety - Certification Board for Professionals in Patient Safety (CPPS) Risk Management certification such as CPHRM, CPPS (Within 12 months upon hire) within 1 Year OR
• Certified Professional in Healthcare Risk Management (CPHRM) - American Hospital Association Certification Center (AHA-CC) Risk Management certification such as CPHRM, CPPS (Within 12 months upon hire) within 1 Year

Knowledge Requirements

• Ability to use phone, communicate one on one and in meetings, participate in internal and external meetings.
• Strong interpersonal skills including the ability to interact well with all levels of staff and motivate others; proven leadership skills with strengths in organizational development and the capacity to handle diverse activities in a fast paced environment.
• Experience in quality, patient safety or risk management; ability to use statistical tools; and experience with human factors analysis, root cause analysis, apparent cause development, and common cause coding and trending, preferred. Knowledge of federal regulations regarding patient rights related to grievances also preferred.
• Ability to work under pressure and flexible to respond of unexpected events.
• Other required qualifications include excellent written and verbal skills; computer skills, including word processing and spreadsheets; broad knowledge of hospital systems and standards of care; working knowledge of team development, functions and group dynamics; education in legal aspects of patient care; knowledge of adult learning principles; ability to analyze data; and excellent organizational skills for process development and coordination.
• Preferred Broad knowledge of healthcare regulations including TJC and CMS, state and federal.

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.