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Chief of Patient Risk Management
2 months ago
Reporting to the Assistant Vice President of Quality and High Reliability, with a matrix reporting structure to the Vice President for Risk Management Services, the Director of Patient Claims is responsible for steering, designing, executing, and sustaining the Risk Management Program aimed at mitigating the frequency and severity of losses to the organization. This role encompasses the management of medical professional liability associated with any organizational associate, including employed healthcare providers. The Director will fully support the captive insurance initiative, as well as early intervention, patient safety, and loss prevention strategies. The position safeguards the organization's assets through effective risk and claims management and a commitment to patient safety. These responsibilities are conducted in compliance with all relevant laws, regulations, and the organization's policies and standards.
Key Responsibilities
- Formulates, and upon approval, executes and oversees internal risk management and patient safety initiatives in alignment with federal, state, and regulatory requirements.
- Leads the investigation, documentation, and evaluation of all actual and potential liability risk exposures, including Patient Safety Events (PSEs). Develops and implements strategies to minimize or eliminate these risks. Regularly analyzes data and reports findings to hospital administration and the Risk Management Department.
- Creates, presents, and assesses educational programs related to risk management principles, current issues, regulations, and incident prevention.
- Recruits, trains, and orients personnel, including risk management consultants and data analysts. Monitors and supervises risk management and claims activities, evaluates performance, and recommends personnel actions such as promotions and disciplinary measures. Maintains ongoing communication with staff to review programs and share updates.
- Actively engages in the management of medical professional and general liability claims under the guidance of the Risk Management Department.
- Oversees the management of claims, including reserves and communication with patients and families, ensuring thorough documentation and evaluation.
- Collaborates closely with leadership to manage the financial aspects of the medical professional liability and corporate general liability claims program, ensuring timely recognition and recording of liability exposure.
- Establishes and maintains positive relationships with insurers, legal representatives, mediators, and other stakeholders; takes a leadership role in broader tort reform initiatives.
- Develops and sustains a strong collaborative relationship with organizational leadership regarding all facets of claims and litigation management, keeping them informed on the status of claims.
- Delivers presentations to senior leadership on significant cases and trends.
- Conducts training sessions for clinical staff on risk management strategies, documentation practices, and effective communication with families regarding risk and claims management.
Education
- Doctor of Jurisprudence required.
- Bachelor's degree in Nursing preferred.
- 5-7 years of relevant experience required.
- Licensed Attorney (requirements vary by state) required.
- Registered Nurse - State Licensure and/or Compact State Licensure preferred.
- Exceptional oral and written communication skills, with strong organizational and prioritization abilities.
- Ability to build strong working relationships with clinical and administrative leadership.
- Empathetic demeanor with the capability to connect with patients and families during stressful situations.
- Proficient in identifying, analyzing, and evaluating complex clinical and legal issues and proposing solutions.
- Ability to make independent and timely decisions in complex situations.
- Proven ability to work effectively as a team member and at times as a leader.
- Strong judgment and creative problem-solving skills, with a high level of integrity and personal ethics.
