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Director, Risk Management
1 month ago
The Director, Risk Management will lead the Risk Management Department and oversee the risk management and claims functions for UC San Diego Health. In this role, the Director will serve as the key representative for the Department in engagements with executive leadership and in collaborations with other Departments and areas. The Director reports directly to the Chief Counsel for Health Sciences and will be responsible to oversee the adequacy and allocation of resources to manage risks and claims for the clinical enterprise at UC San Diego Health. Will work closely with the CEO, CMO and others to support and promote optimal patient care and patient care environments.
Key Responsibilities:
Please make sure you read the following details carefully before making any applications.
- Oversees the implementation of new initiatives or processes through subordinate management. Ensures consistency in managing risk in highly sensitive areas, such as mandatory reporting of abuse, 5150 hold requirements, DEA licenses, organ donation, and end of life issues.
- Evaluates functionality and quality of risk management policies and programs from a regulatory compliance and strategic standpoint. Ensures that best practices, advanced metrics, and business analytical tools are properly utilized and functioning optimally to support sound decision-making. Manages the assessment of loss potential and recommends operational changes as needed, throughout the medical center and / or health system.
- Defines departmental objectives and strategic plans for each division based on functional objectives. Identifies and implements risk management processes and strategies to achieve reductions in liability and cost. Evaluates needs for improvements in quality patient care and patient safety and recommends initiatives to meet these needs.
- Coordinates the resource needs for areas of responsibility, including the review and approval of budgetary recommendations. Oversees the administration of insurance programs designed to protect the organization from loss.
- Coordinates with Regulatory Affairs, Compliance, Legal, Medical Staff leadership, Security, Title IX, etc. on complex issues.
- Represents risk management across the medical center on interdisciplinary committees. Advises senior management on a range of topics impacting the medical center, such as patient safety and high quality care. May lead efforts with cross-functional peer group managers, involving matters between other divisions. Collaborates with IT managers to develop and implement new or improved risk management information systems and coordinates efforts across large and/or multiple units.
- Acts as a liaison to state licensing boards on behalf of the institution and UCSDH clinical professionals (reporting, responding to subpoenas, responses on behalf of UCSD licensed providers, etc.).
- Facilitates and oversees case coordination between and among outside counsel, UCOP Office of General Counsel, UCOP Risk Services and UC's third party administrator on professional liability, employment liability, and general liability cases; assist with trial prep, depositions, arbitration/mediation.
- Manages and administers UCSD Health's component of the UCOP Risk Services' Professional, Medical and Hospital Liability Program.
- Works with UCSDH leadership, clinical professionals, patient experience, etc. on patient grievances, patient dismissals and Behavioral Agreements; serves as member of Patient Grievance Review Committee.
- Works with Regulatory Affairs reviewing complaints to determine appropriate adverse event reporting, EMTALA, TJC matters, etc.
- Reviews and assesses professional liability claims and litigated cases with respect to standards of care, causation, and damages. Handles early resolutions, assists with disclosure of adverse events. May represent the organization in litigation matters and coordinates with attorneys. Assists in the negotiation of settlement agreements.
- Manages and facilitates Risk relationships with UCSDH affiliates ensuring the execution and implementation of Joint Risk Management and Defense Agreements (i.e. Radys, ECRMC, etc.)
- Provides advice and counsel to the Medical Staff Professionalism Committee on issues involving provider behavior; performs initial fact-gathering, prepares summary reports, and presents findings to MSPC upon request.
- Ensures subordinate staff follow procedures in claims management, including liaison with involved parties and overseeing responses to discovery requests. Counsels physicians, nurses, and staff in retrospective reviews following adverse events or claims.
- Collaborates with risk management staff and counsel on professional liability strategy. Ensures subordinates are utilizing best practices and compliant with internal policy and external regulations.
- Determines the curriculum and content for risk educational programs for the organization's understanding, management and treatment of risk, and comprehensive orientation program. Provides education / training throughout the organization on a variety of Risk related topics (i.e. patient conduct, consent, risk mitigation, documentation, disclosure, employment issues, discipline/dismissal, disability management, etc.).
- Proposes staffing changes, justifying how staffing patterns meet strategic needs. Participates in the development of career series, defining development and growth consistent with workforce planning. Develops core competencies, assessment plans, and tools for risk management personnel.
- Provides mentorship to risk management managers and supervisors. Reviews and approves individual professional development plans, with succession planning needs in mind. Identifies the need for professional development initiatives for staff. Encourages all staff to develop expertise, publish, and teach.
- Ensures 24/7 department coverage for UC San Diego Health.
- Other duties as assigned.
MINIMUM QUALIFICATIONS
Bachelor's degree in a related area and eight or more years of relevant experience in healthcare risk management, or equivalent combination of experience, education and training.
Demonstrated experience in Risk Management for a large, complex healthcare organization.
Demonstrates a high degree of knowledge in state and federal health law as applied to Risk Management principles, including healthcare consents, HIPAA, CMIA, EMTALA, patient abandonment, patient dismissal, end-of-life issues, advanced directives, licensing board reporting requirements, Medicare Conditions of Participation, TJC accreditation standards, the Healthcare Quality Improvement Act (and National Practitioners Data Bank), and mandatory child and elder abuse reporting.
PREFERRED QUALIFICATIONS
Advanced degree in a relevant field of study, Juris Doctor (J.D.) highly preferred.
Ten or more years of experience working in Risk Management within a large, complex health system, and sophisticated knowledge of health care operations.
Certified Professional in Health Care Risk Management(CPHRM)
Risk Management experience within University of California system.
Current UC San Diego Health employee.
SPECIAL CONDITIONS
Must pass a background check.
Must pass physical, drug screen and TB test.
Must be able to work various hours and locations based on business needs.
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