Risk Management Director

As a Risk Management Director at Providence Health & Service, you will play a critical role in ensuring the organization's compliance with regulatory requirements and mitigating potential risks. Your primary responsibility will be to develop and implement effective risk management strategies, working closely with the Executive Director and other stakeholders to identify and address potential threats to patient safety and organizational reputation.

Key Responsibilities:

• Develop and maintain departmental policies, procedures, and objectives related to risk management and patient safety.
• Direct the work of risk specialists, patient safety officers, and other team members to ensure effective risk management and patient safety functions.
• Investigate and analyze risk management and patient safety events, identifying root causes and developing strategies to prevent recurrence.
• Collaborate with regulatory agencies, insurance companies, and other external stakeholders to ensure compliance with regulatory requirements and mitigate potential risks.
• Develop and implement education programs for medical staff, hospital departments, and other stakeholders on risk management and patient safety best practices.
• Provide investigative support for all activities related to actual or alleged Medical Center liability, ensuring Executive Director is kept apprised of status of discovery and investigations.
• Ensure appropriate executive leadership is kept informed of status of litigation and obtain authorization for payment of monies to settle claims when necessary.
• May be required to attend legal proceedings as a representative on behalf of the organization in conjunction with legal counsel.
• Act as a liaison between respective PSJH enterprise risk management, integrity, compliance, privacy, and/or legal departments.
• May act as a delegate of the Executive Director at internal and external meetings.
• Coordinates insurance new/renewal activities and submits required documentation.
• Provides support for regulatory agency survey and reporting activities, including CDPH, DMH, DHS, CMS, FDA, and the Joint Commission in collaboration with the regulatory program manager(s).
• Coordinates mandatory and statutory reporting to licensing, accrediting, and other governmental bodies under the direction of the Executive Director.
• Maintains and disseminates knowledge of accreditation and licensing standards pertinent to improving organization performance and maintaining survey readiness.
• Oversees and coordinates continued survey readiness for all regulatory agencies.
• Provides education to medical staff and hospital departments on standards affecting their areas of responsibility.
• Ensures excellence in patient care consistent with TJC, title 22, CMS, CDPH, and other regulatory agencies through clearly defined performance standards and verifying the proficiency of staff.
• Prepares and submits appropriate facility licensing documentation in collaboration with the regulatory program manager(s).
• Completes pre-surveys ensuring facility compliance. Inspections may include internal and external facility inspections (roof, grounds, basement, etc.).
• Provides investigative and other support for event analysis (Root Cause Analysis, Intense Analysis, Failure Mode Effect Analysis).
• Coordinates facility-wide communication of lessons learned and improvements from event analysis (RCA, IA, and FMEA) in collaboration with regulatory and/or patient safety program manager(s).
• Under the supervision of the Executive Director, acts as facility Super User of Unusual Occurrence Report system, assigning permission levels to managers/others, reviewing and analyzing UOR submissions, and prepares quarterly summaries of UOR data for Leadership and committee support.
• Works to reduce facility risks and promotes patient safety.
• Participates in hospital/medical staff committee meetings and Medical Center as required. Attends and serves on professional/civic service organizations as hospital representative.
• Interacts with legal counsel and insurance claims representatives. Collaborates to determine event causation, claim worth, mediation, completion of discovery and interrogatories.
• Manage the claims process for those actions that are not covered under the self-insured trust.
• Oversees analyzing clinical processes, identify potential risks for patients and develop strategies to maximize safety, effectiveness, and efficiency. Along with the Patient Safety Officer, the Risk Manager develops the education regarding patient safety, and works to influence leaders to achieve measurable improvements in patient safety that will support the sustainability of reductions in medical/healthcare errors and other factors that contribute to unintended adverse patient outcomes.
• Coordinates Physician Peer Review:
  • Oversees the performance of case finding per Interdisciplinary/Departmental Specific, Medical Staff Indicators for peer review in collaboration with the quality department.
  • Assigns peer review cases to appropriate Medical Staff reviewers and monitors progression of case through committees until completion.
  • Maintains database of peer review records and develops and designs reports and queries to support committee needs.
  • Prepares summaries of peer review data for the Executive Director, Clinical Risk Manager(s), Leadership, Medical Staff, Board, and other committees as necessary.
  • Keeps Clinical Risk Manager(s), Executive Director, Chief Medical Officer, and Medical Staff Officers apprised of status of peer review cases and any issues that may exist.
  • Attends hospital and medical staff committee meetings as required.
• Enhances professional growth and development through participation in educational programs, professional affiliations, current literature, in-service meetings, and workshops.
• Willingly performs other related duties outside immediate work area as assigned or required.

Qualifications:

• Bachelor's Degree in Nursing or Healthcare related field.
• Master's Degree (preferred).
• Upon hire: Certified Professional in Healthcare Risk Management (CPHRM) (preferred).
• 5 years of supervisor/management experience overseeing comparable functions.
• 5 years of experience working with risk management and regulatory agency issues in healthcare.
• Experience developing strategic plans and initiatives.
• Knowledge of national healthcare trends, multi-disciplinary professional practice models, information systems, quality management, and customer service needs.
• Knowledge of the fundamentals of risk management, privacy, compliance, patient safety, and/or performance improvement.
• Knowledge of regulatory requirements, state, and federal laws.
• Work efficiently and effectively in a matrix structured environment.
• Must possess strong presentation and interpersonal skills that display a presence of relevant knowledge in a wide range of settings.
• Must possess skills and understanding of hospital clinical healthcare operations and quality data management.
• Quality and Safety
• Driving improvement
• Patient Experience
• Risk Assessment
• Conflict Resolution
• Staff Development
• Efficiently problem solve, while dealing with a diverse set of systems and individuals.
• Ability to interact effectively with physicians, patients, and employees at all levels of the organizational hierarchy.
• Maintaining good working relationships both inter- and intra-departmentally.
• Ability to manage sensitive and confidential issues.
• Respond to multiple duties simultaneously.
• Meet strict deadlines.