Risk Management Consultant IV

Maintains risk management programs by conducting moderately complex audits and analyses to evaluate risk management programs. Prepares moderately complex reports and specialized data analysis for professional liability cases, risk management trends and issues, significant events, and near misses. Collaborates and coordinates across functions (e.g., claim management, legal, patient safety, clinical quality) to monitor and identify risks and threats. Applies protocols and some judgment and discretion in rapid response and situation management for moderately complex incidents. Provides consultative services for clinical and non-clinical staff on a broad range of complex risk management issues. Serves as a resource and disseminating information to providers, staff, and external partners on risk trends and avoidance. Interprets and complies with State and Federal laws, regulations, patient rights, and professional ethics.

• Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes.
• Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.
• Ensures compliance by: interpreting and complying with State and Federal laws, regulations, patient rights, and professional ethics; upholding and modeling compliance with Kaiser Permanente's policies and procedures and applicable federal and state laws and regulations; serving as a liaison to assist other departments in complying with moderately complex accreditation and regulatory risk management requirements (e.g., policies and procedures, legal claims manager), identifying and recommending solutions; preparing for and participating in moderately complex regulatory audits and related projects (e.g., annual audits, accrediting bodies); and maintaining knowledge of changes to laws, regulations, codes, policies, and standards as they apply to risk management.
• Engages in Risk Management consulting by: providing consultative services for clinical and non-clinical staff on a broad range of complex risk management issues; contributing to the planning and implementation of communications, outreach, and education as part of a comprehensive response plan to mitigate risk; providing guidance as requested by participating in committees related to risk management activities; and monitoring new practices to identify and mitigate additional risks and assist departments in minimizing and avoiding liability.
• Engages in documentation, analysis, and reporting by: using sophisticated risk management data sources to conduct moderately complex tasks; modeling application of guidelines to document professional liability cases, risk management trends and issues, significant events, and near misses; collaborating on the design, development, and production of reports on scheduled cadence to senior leadership, Board committees, and regulators; preparing moderately complex reports and specialized data analysis for professional liability cases, risk management trends and issues, significant events, and near misses; conducting standard and nonstandard analyses to identify trends and facilitate improvements; utilizing reports and analyses to develop recommendations and action plans for moderately complex issues in collaboration with appropriate stakeholder groups; applying judgment and discretion to research risk exposure data and prepare underwriting submissions in the areas of insured risks, including general and professional liability and consulting on certificates of insurance, indemnification letters, and credentialing responses as they relate to insured risks, including general and professional liability programs; and investigating, analyzing, and resolving potentially compensable events, compensable events, and regulatory investigations.
• Conducts Risk Management education and training by: developing and implementing risk management-related training programs for providers, staff, and/or external audiences as needed; maintaining and applying up-to-date knowledge of risk management best practices through training and development, and sharing learnings within team; measuring the impact and monitoring sustainability of education and training, making suggestions for improvements; maintaining awareness of risk management industry trends to help determine education and training needs for providers, staff, and external partners; and serving as a resource and disseminating information to providers, staff, and external partners on risk trends and avoidance.
• Responds to Risk Management incidents by: applying protocols and some judgment and discretion in rapid response and situation management for moderately complex incidents; independently gathering information and conducting investigations to determine impact and appropriate actions; applying knowledge and judgment to act as a liaison in resolving and/or mitigating moderately complex incidents, escalating more complex incidents with unusual conditions or factors; determining root cause(s) and suggesting meaningful improvements and corrective actions to prevent recurrence; and facilitating organizational awareness and handling of moderately impactful clinical risk issues.
• Maintains Risk Management programs by: implementing, and assisting with planning and developing parts of integrated, locally-relevant and/or enterprise-wide risk reduction and prevention programs; conducting moderately complex audits and analyses to evaluate Risk Management programs; and consistently making recommendations to enhance existing programs based on analyses and observations.
• Engages in threat monitoring and risk prevention by: collaborating and coordinating across functions (e.g., claim management, legal, patient safety, clinical quality) to monitor and identify risks and threats; analyzing, validating, and interpreting new and ongoing risks and threats in partnership with other functions (e.g., Quality Management, Patient Safety, Operations, Customer Service Call Center, Member Services, EH&S, and Security); providing advanced technical consulting and analytical support to a comprehensive risk financing program preserving corporate assets in order to reduce the impact of financial loss in the areas of property, casualty, workers compensation, general liability, and professional liability; coordinating risk and threat response to implement action plans and address identified problems; reviewing and analyzing high-level product safety risks; independently preparing initial processing and receipt of clinical / safety events; and providing risk management expertise to support the reduction of preventable errors in health care delivery.

• Minimum one (1) year of experience in a leadership role with or without direct reports.
• Minimum four (4) years of experience using medical terminology.
• Bachelors degree in Analysis, Research, Statistics, Health Care (e.g., Registered Nurse), Healthcare Administration, Health Care Management, Economics, Business, Homeland Security, or related field AND minimum four (4) years of experience in risk management, quality program, claims management, patient safety, or a directly related field OR Minimum seven (7) years of experience in risk management, quality program, claims management, patient safety, or a directly related field.

• Knowledge, Skills, and Abilities (KSAs): Confidentiality; Risk Assessment; Adaptability; Organizational Skills; Risk Identification; Health Information Systems; Change Management; Negotiation; Business Process Improvement; Loss Prevention; Risk Management; Compliance Management; Health Care Compliance; Applied Data Analysis; Business Relationship Management; Conflict Resolution; Relationship Building; Member Service; Patient Safety; Microsoft Office; Trusted Advisor; Legal Risk Management; Personal Courage; Insurance Regulations, Policies, and Procedures; Insurance Contracts; Clinical Risk Assessment

• Three (3) years of experience with risk management-related applications (e.g., event reporting software, case management software, patient safety database).
• Two (2) years of Early Resolution or Mediation training/experience.