AVP Claims, Medical Professional Liability

2 months ago

Columbia, South Carolina, United States MEDSTAR HEALTH Full time

General Summary of Position
Responsible for managing MedStar's medical professional liability and corporate general liability claims and suits, including those involving any MedStar associate, including employed physicians. Responsible for fully supporting MedStar's captive insurance program, Greenspring Financial Insurance Limited (GFIL), as well as MedStar's early intervention, patient safety and loss prevention programs. The strategic importance of this position is to successfully manage the significant financial and reputational exposure to MedStar and MedStar Medical Group as a result of medical professional liability claims and the volatile medical professional liability climate in the jurisdictions in which MedStar operates. Reporting directly to the Vice President for Risk Management Services with matrix reporting to MedStar's Chief Medical Officer, and responsible for maintaining a strong working relationship with MedStar corporate leadership and hospital and ambulatory operational and senior leadership, the Assistant Vice President (AVP) has matrix responsibility for the hospital and ambulatory risk managers/directors.

Primary Duties and Responsibilities

Develops and contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Ensures compliance with hospital/facility policies and procedures and governmental/accreditation regulations.Provides 24/7 professional support and advice to MedStar's ambulatory care programs, hospitals, outpatient surgery centers, urgent care centers, and MedStar's physicians, nurses, and other clinicians in response to any patient care-related issues that have the potential for liability.Responsible in the event of a serious unanticipated outcome to provide support to the clinical staff to ensure that appropriate action and response occurs in a timely fashion. Responsible also to activate MedStar's Early Intervention Program, to include: establishing contact with the patient and/or family as appropriate; advising staff regarding communication with the patient/family, disclosure, apology when appropriate, and documentation. Assist the patient and family to address immediate needs, maintain ongoing relationship with the patient/family until resolution, which could include ongoing financial support or compensation.Manages MedStar's patient bill hold system. Works with hospital and ambulatory leadership regarding decisions to waive bills in connection with a risk event or an adverse event.Works closely with the MedStar VP, Risk Management to manage financial aspects of the MedStar's medical professional liability and corporate general liability claims program including establishing and maintaining a sound claims-reserving program that ensures that liability exposure is timely and adequately recognized and recorded.Oversees outside defense counsel assigned to provide professional legal services in connection with claims and suits. Is responsible for overseeing all aspects of litigation management involving over 200 claims and suits, including the selection of experts, development of litigation strategy, and ultimate disposition of each claim and suit. Reviews and analyzes all defense counsel-prepared case evaluation reports. Reviews with defense counsel the findings of all medical experts and discusses with defense counsel the implication of these findings in connection with the defensibility of the case. Participates in the meetings held by defense counsel with MedStar-employed physicians, nurses and others.Assigns and works with defense counsel retained to represent physicians, nurses and other licensed providers in connection with matters referred to, or complaints filed, with any of the licensing agencies in Maryland and DC.Collaborates with the Office of General Counsel regarding various legal matters including but not limited to, breach of privacy complaints, workplace violence issues, Office of Compliance matters, subpoenas, policies and procedures, amendments to medical records, termination of patient/physician relationships, and other legal/risk claims and events.Works with IT department for evidence to support claims and suits in litigation. Investigates audit trial data, metadata, and other information in the electronic medical record for evidence to utilize to defend claims.Develops and maintains ongoing positive relationships with insurers, attorneys, mediators, legislators, and other constituents; takes a leadership role in broader tort reform efforts both locally and nationally.Responsible for developing and maintaining a strong positive working relationship with all MedStar hospital and ambulatory leadership including hospital presidents, vice presidents of Medical Affairs, and Medstar Medical Group senior leadership regarding all aspects of claims and litigation management, keeping them fully informed regarding the status of claims or suits that involve that hospital or business unit.Maintains a strong positive matrix reporting relationship with the hospital-based risk managers and ambulatory managers responsible for risk and claims management issues to insure that: all incidents that have the potential to result in claims of liability are identified, investigated and reported in a timely manner; and all loss prevention opportunities are identified and that appropriate steps are taken to ensure that similar events do not occur.Provides leadership within the MedStar system for all aspects of identification, management and successful resolution of claims involving medical professional liability and corporate general liability.Demonstrates strong organizational, prioritization and delegation skills while working with minimal supervision.Routinely provides presentations to the Chief Medical Officer, Chief Nursing Officer, Chief Operating Officer and Chief Quality Officer on significant cases.Represents MedStar Health in a most positive manner to all those outside of MedStar, including its patients and their families, physicians, nurses, the business and legal community and the community at large.Conducts training for residents, physicians, nurses and other clinical staff regarding risk management strategies, appropriate documentation in medical records, disclosure conversations with family members and other risk and claims management topics.Participates in meetings and on committees and represents the department and business unit in community outreach efforts. Participates in multidisciplinary quality and service improvement teams and maintains effective working relationships with other departments.

Minimum Qualifications
Education

  • Bachelor's degree Juris Doctor required
  • Advanced degree preferred

Experience

  • 5-7 years Professional and general liability claims/litigation management experience required and
  • Clinical training preferred

Licenses and Certifications

  • Must be licensed to practice law in the United States. Must Obtain license to practice law either in the State of Maryland, District of Columbia, or State of Virginia within six (6) months from date of hire.
  • Professional insurance designations Upon Hire preferred

Knowledge, Skills, and Abilities

  • Excellent oral and written communication skills, including presentation presence.
  • Ability to form strong working relationships with both clinical and administrative leadership.
  • The ability, interpersonal skill and empathetic demeanor to be able to successfully connect with patients and their families and MedStar staff, including nurses and physicians, at times of high stress. Ability to identify, analyze and evaluate complex clinical and legal problems and recommend solution.
  • Able to make independent and timely decisions involving complex situations. Possesses the ability to work as an effective member, at times the leader, of multiple teams.
  • Solid judgement, conceptual and anticipatory skills with a proven ability to think creatively and be flexible in order to meet all challenges. Proven high level of integrity and personal ethics.

This position has a hiring range of $177,100 -
$250,100

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