RN, Sr. Risk Consultant

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more – in our careers and in our communities.

Job Description Summary:

Given that the organization self-insures for professional liability claims, it is essential that the Sr Consultant Risk Management effectively engage in Risk Assessment, Analysis, Prevention, and Education activities intended to reduce/minimize the frequency and severity of losses, and subsequently, favorably protect corporate assets. To accomplish this, the Sr Consultant's primary job focus evolves largely around the following activities; monitor for and capture all patient outcomes that have the potential to progress to professional liability claims against the hospital; analyze, interpret, and generate reports regarding the effectiveness and appropriateness of clinical care & treatment; works directly with complainants and claimants to investigate, analyze, and resolve allegations of professional negligence; where indicated, is given authority to negotiate financial settlements with claimants; is assigned to assist the General Counsel and external trial counsel in managing various aspects of formal litigation cases; functions as a Third Party Administrator/claims adjuster to manage, and as authorized, to negotiate claims settlements for (self-insured) General Liability claims; otherwise functions as the lead, on-site insurance contact for collecting and submitting claims reports/data associated with a variety of casualty lines of insurance coverage (e. g. property damage, fleet auto accidents, pollution/environmental exposures, etc. ); provides standardized and customized Risk Management specific in services and presentations to various audiences.

Responsibilities And Duties:

Patient Complaint/Claims management
35%
Meets with patients, families, visitors, as well as clinical, ancillary, & administrative staff, and physicians, to assist/consult with, or take a lead role as indicated, in confronting and managing serious patient and visitor complaints & grievances, typically alleging substandard, or inappropriate professional care and treatment ; investigates the validity of the complaint/claim, analyzes medical records, interviews associates as indicated, negotiates and manages resolution of complaints and claims while balancing corporate interests and service recovery ; consults with the Risk Manager for case management, and settlement authority in negotiating and settling patient claims. 2. Unusual occurrences management-20 % 1 Analyzes all UORs & miscellaneous hospital reports on-line UORs, Attorney Requests for Medical Records, Quality variance reports, et c and identifies those having professional liability claim potential; initiates follow-up and/or investigative activities where indicated; reports significant findings to the Risk Manager, Legal, and Safety & Quality leadership; monitors for and reports significant UOR trends to . 2 Monitors for and generates dedicated reports of Safety incidents; notifies designated management/ leadership personnel of significant findings; actively participates in follow-up and investigation of incidents, participates in all Safety Event meetings/Root Cause Analyses; participates in Disclosure discussions with patients & families as requested by Hospital Safety & Quality leadership; completes clinical chart reviews and presents case summary at monthly Reserves meeting for significant/serious incidents. 3. Litigation management-
20%
Functions as the