Risk/Claims Manager
2 weeks ago
Manage clinical risk functions associated with professional liability claims, incident, and trends with WVUHS's captive, self-insured and commercially insured programs. Analyze claims data across WVUHS to identify and implement necessary risk control programs and educational programs across various healthcare specialties and hospitals. Work closely with the WVUHS captive and excess carriers to implement recommendations or requirements to satisfy underwriting and risk control needs, as well as those of System leadership and Legal department.
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor's degree.
EXPERIENCE:
1. Seven (7) years of experience in a healthcare setting.
2. Three (3) years of experience directly working for or with professional liability insurance carriers or captives.
3. Five (5) years of experience in claims and related legal proceedings.
PREFERRED QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Master's degree in nursing or medical-related field.
2. Registered Nurse License.
EXPERIENCE:
1. Five (5) years of experience directly working for or with professional liability insurance carriers or captives.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Identification, risk evaluation and coordination of corrective action implementation related to potential medical malpractice risk or claims issues.
2. Review captive and carrier loss runs and incident reporting systems to identify trends for risk control or corrective action plans.
3. Interface with legal counsel for medical malpractice defense and related regulatory concerns.
4. CRM Liaison with excess and reinsurance carriers' personnel on clinical risk related requirements or claim issues.
5. Work closely with clinical departments to ensure the organization's procedures and policies are being followed
6. Provide and/or coordinates intervention and education related to risk management issues to promote safe work practices and quality care and services.
7. Conduct proactive educational sessions and presentations with clinical staff to support risk recognition and risk reduction.
8. Investigate and analyze root causes, patterns, or trends that could result in compensatory or sentinel events. Provides leadership in the identification and implementation of corrective action plans where appropriate.
9. Develop reports and presentations to effectively provide the clinical or business case for risk control or corrective action plans to hospital leadership, captive and financial groups.
10. Actively participate in, or facilities, committees related to clinical risk management, patient safety, and quality improvement.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Must have manual dexterity to operate keyboards, telephones and other business equipment
2. Must have reading and comprehension ability and visual acuity must be within normal range
3. Ability to sit for extended periods of time
4. Long periods of standing or walking may be necessary
5. Some travel to other WVUHS hospital/entity locations
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. General office-like setting, with occasional travel required to other WVUHS facilities in West Virginia and the surrounding region.
SKILLS AND ABILITIES:
1. Skilled in analyzing data to identify risks, gaps, root causes, patterns, or trends.
2. Skilled in communication and collaboration.
3. Presentation skills.
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
SYSTEM West Virginia University Health System
Cost Center:
634 SYSTEM Risk Management
Address:
3040 University Ave
Morgantown
West Virginia
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