Clinical Risk Manager

Overview

The Clinical Risk Manager is responsible for the management, on-going development, implementation, coordination and documentation of NAH risk reduction programs, error prevention, and assist with claims management. S/he is available for ethics committee consultation, educational programs, and complying with risk management related standards as determined by CMS and other regulatory agencies, in support of controlling and minimizing the loss in protection of system assets. The Clinical Manager integrates data and complex systems analysis, risk management education, and assists with administration of the insurance program. The Clinical Risk Manager partners closely with Patient Safety, Patient Relations, the Malpractice Claims Manager, and Legal in response to risk and safety events, including near misses. The Clinical Risk Manager is available to support NAH colleagues, including physicians and other clinicians, in in-the-moment responses to risk events, disclosures of unanticipated outcomes to patients and families, and resolving questions or concerns prior to and during treatment at an NAH facility.

Responsibilities

Risk and Safety Response* Supports and advises clinical staff in response to risk events, safety events, near misses; participates in care conferences and cross-disciplinary meetings to facilitate highest quality patient outcomes.

* Is available to participate in or facilitate disclosures of unanticipated outcomes to patients and families, in collaboration with treating physicians, clinicians, and Chief Quality and Medical Officers.

* Participates in safety huddles; collaborates with Patient Safety team in advance of safety huddles to facilitate huddles and responses.

* Assists in resolution of treatment issues, patient complaints, and potential claims within guidelines of administration and legal counsel.

* Acts as a resource/internal consultant on resolution of medical malpractice inquiries of physicians, administrators, staff, and patients.

Claims Management* Communicates with legal counsel, the Malpractice Claims Program Manager and insurance carriers regarding potential actual claims.

* Utilizes data to provide statistics and reports for identifying problem areas and forecasting future losses.

* Assists Malpractice Claims Program Manager as needed with witness interviews, depositions, and court proceedings as related to clinical claims management.

* Assists with chart reviews for quality, patient safety, and risk management.

* Initiates, coordinates, and manages all investigational and evaluation activities associated with professional and general liability occurrences.

* Assists with patient grievance workflow.

Enterprise Risk Management* Collaborates with department directors to identify and mitigate department related risk.

* Collaborates with the hospital Patient Safety and Quality Departments to analyze events and recommend process improvements.

* Collaborates with NAH Departments including Quality, Patient Safety, and clinical units to promote a culture of quality and safety.

* Provides recommendations for change in clinical policy or procedure to mitigate risk.

* Remains current on key risk management topics, researching relevant trends and presenting findings to the NAH Risk Management Committee or other designated committee on a semi-annual basis.

* Participates on committees or hospital projects.

* Provides basic and complex preventative risk management assessment of processes, procedures, and programs (education, consultation, liaison activities, and emergency assistance to clinical care providers and facility leadership).

Communication* In collaboration with the full Risk Management team, provides timely risk management direction, functioning as the liaison between NAH staff and the office of Chief Legal Counsel and/or retained outside legal counsel.

* Escalates urgent and non-urgent matters through Department, Hospital, and System leadership.

Education* Plans, develops, and presents clinical risk-related information to administration, medical staff, leadership, and the community.

* Coordinates with medical staff services to provide risk management information into the credentialing process.

* Provides risk related education and status updates to the board, senior leadership, and directors.

Compliance/Safety* Responsible for reporting any safety related incident in a timely fashion through the Midas/RDE tool; attends all safety related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.

* Assists in ensuring staff complies with standards as required by Appropriate Regulator Agencies, OSHA and other regulatory entities.

* Completes all company mandatory modules and required job specific training in the specified time frame.

* Maintains current knowledge on health care trends, facility strategic plan, and department service needs.

Qualifications

EducationBachelor's Degree- Required

Master’s Degree- Preferred

Certification & LicensuresRegistered Nurse license- Required

Certified Healthcare Professional in Risk Management (CPHRM)- Required within 24 months of hire

ExperienceMinimum 5 years of recent acute care health care experience- RequiredMinimum of three (3) years of acute care risk management experience- Preferred

Healthcare is a rapidly changing environment and technology is integrated into almost all aspects of patient care. Computers and other electronic devices are utilized across the organization and throughout each department. Colleagues must have an understanding of computers, and competence in using computers and basic software programs.