Employment Type:

Full time

Shift:

Day Shift

Description:

CLINICAL RISK MANAGER

EASTERN ORGEON

SUMMARY:

The Clinical Risk Manager is to ultimately provide a safer hospital and clinic environment by mitigating or reducing risks for all individuals within the organization. Serves as a resource for all colleagues and providers on medico/legal concerns. Investigates Event Reports and EMTALA related concerns and identifies major trending patterns.

Analyzes allegations of claims and complaints against the organization, and corresponding documentation (including medical record review, security reports/video, etc.). Interviews employees, patients, families, and physicians for details of events. Documents chronological summaries of events and research processes in a medical/legal perspective. Participates in the risk management reduction strategies with the Risk Management team.

REQUIREMENTS:

1. Must have active RN license; BSN preferred.

2. Certified Professional in Healthcare Risk Management (CPHRM) preferred.

3. 3 years of nursing experience in a clinical role that gives exposure to Infection Control, Quality, Risk, etc. required

WHAT YOU WILL DO:

• Knows, understands, incorporates, and demonstrates the Organization's Mission, Vision, and Values in behaviors, practices, and decisions.

• Must be highly motivated and self-directed and can work independently. Must have strong written and verbal skills.

• Must have the ability to work under pressure with time constraints, including presenting to all associates in a respectful and professional manner as part of SAH’s Core Values Participates in daily Safety Huddles and provides reports for the department and support for other departments as needed.

• Assists in the oversight and maintenance of the system-wide Event reporting system.

• Analyzes Event reports to determine causes and to suggest remedial actions. Reassign events to appropriate department/clinic leadership and/or to peer review.

• Ascertain clinical course of patient from documentation and demonstrate knowledge of regular processes pertaining to nursing care, departmental/clinic functions, etc.

• In collaboration with the AOC, Clinical Coordinators, or applicable department/clinic leadership, determines and coordinates initiation, leading, and follow up of CERT’s and Root Cause Analysis (RCA) processes. Expert in Apparent Cause Analysis (ACA) and Common Cause Analysis (CCA) processes and can lead and/or provide guidance and education as needed.

• Oversees and tracks the implementation of corrective action plans resulting from the CERT’s, ACA’s RCA’s process, including Common Cause Analysis (CCA) as needed.

• Notifies TH insurance of all actual and potential adverse events, SRE’s, SSE’s and/or potential compensable events.

• Clinical Risk Manager will work with legal department to conduct EMTALA investigations and provides summary reports to legal for determinations on a case-by-case basis.

• Assists and/or coordinates debriefing processes as needed.

• Assists and /or coordinates disclosure processes with Providers and Administration as needed.

• Works collaboratively with the Patient Relations Department or group office managers/directors to complete appropriate responses on patient complaints and grievances, and/or assists with advice on patient concerns as needed. Serves as a lesion with Patient Relations or office manager/director if the patient grievance is elevated.

• Medical Group Clinical Risk Manager will work with providers and/or group managers/directors on patient dismissals/terminations.

• Assists with the billing adjustments and write off determinations, and Patient Accounts Review Team.

• Manages or supports processing of subpoenas, court orders or other legal requests from attorneys.

• Interacts with the system office to manage corporate lines of insurance (GL/PL, WC, property, auto, etc.) related issues/requests, i.e., certificates of insurance, renewal processing, claims histories, bonds, etc.

• Is the contact and local support for claims processing related to general or professional liability. Manages and uploads new claims in the STARs “ClearSight” module.

• Interacts with claims management in the system office, local attorneys, and external defense attorneys. Processes requests for interrogatory or requests for production materials and provides it to defense attorneys per their request. Participates in Board of Medicine hearings, court hearings or trials as requested as the facilities’ representative.

• Conducts pro-active Risk Assessment to identify, evaluate and develop action plans targeted on addressing variables, insufficient findings, and other opportunities for improvement.

• Assists with coordination of the Trinity MPL Annual Audits. May serve as a lesion and/or resource between Trinity IRMS and leadership working on components of the audit.

• Collaborates with Performance Improvement and Patient Safety in all serious adverse events and associated corrective action plans. May collaborate on quality projects as requested.

• Collects, evaluates, and distributes relevant data related to Events, SRE’s, SSEs, and claims that may include aggregate data, summaries, monthly/annual trend analyses.

• Prepares or provides materials for reports for applicable committees, the medical staff, and the governing board.

• Participates in hospital or medical group committees/teams and/or Boards as requested.

• Provides education for colleagues and providers on risk management related topics. Provides New Hire Orientation and/or annual educational information regarding Event reporting processes and other risk management related topics.

• Maintains awareness of legislative and regulatory activities related to health care risk management.

• Maintains and revises relevant Risk Management policies, plans, and processes as needed.

• Assists the Manager Safety and Risk Management and other Risk Management staff in the triage and assessment of day-to-day risk management needs.

• Participates in after-hours and weekend Risk Management on-call rotation, as requested by the SAHS Manager Safety and Risk Management

Highlights and Benefits:

When Saint Alphonsus takes care of you, you can take better care of our patients. We foster personal and professional growth and offer opportunities that empower our colleagues to develop their careers. Our belief in work-life balance compliments the natural beauty, diverse landscapes, and outdoor recreation lifestyle that is unique to Idaho and Oregon.

• We offer market-competitive pay, generous PTO, and multiple options for comprehensive benefits that begin on day one.

• Benefits for your future include retirement planning and matching, college savings plans for your family, and multiple life insurance plans that can change as your needs develop.

• We are proud to offer Employee Assistance Programs, tuition reimbursement, and educational opportunities to help you learn and grow.

Ministry/Facility Information:

Saint Alphonsus Health System is a faith-based ministry and not-for-profit health system serving Idaho, Oregon, and northern Nevada communities. The health system boasts 4 hospitals, 609 licensed beds, and 73 clinic locations. Through innovative technologies, compassionate staff, and healing environments, Saint Alphonsus' goal is to improve the health and well-being of people by emphasizing care that is patient-centered, physician-led, innovative, and community-based.

• Top 15 Health Systems in the country by IBM Watson Health;

• The region’s most advanced Trauma Center (Level II);

• Commission on Cancer Accredited Program through demonstrating an uncompromising commitment to improving patient survival and quality of life

Saint Alphonsus and Trinity Health are committed to promoting diversity in its workforce and to providing an inclusive work environment where everyone is treated with fairness, dignity and respect. We are committed to recruit and retain a diverse staff reflective of the communities we serve. Saint Alphonsus and Trinity Health are equal opportunity employers and prohibit discrimination against any individual with regard to race, color, religion, gender, marital status, national origin, age, disability, sexual orientation, or any other characteristic protected by law.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.