Employment Type:

Full time

Shift:

Day Shift

Description:

CLINICAL RISK MANAGER

BOISE REGIONAL MEDICAL CENTER

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.

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:

• Analyzes allegations of claims and complaints against the organization, and corresponding documentation (including medical record review, security reports/video, etc.).

• Analyzes Event reports to determine causes and to suggest remedial actions. Reassign events to appropriate department/clinic leadership and/or to peer review. Interviews employees, patients, families, and physicians for details of events.

• Investigates Event Reports and EMTALA related concerns and identifies major trending patterns.

• 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.

• Clinical Risk Manager will work with legal department to conduct EMTALA investigations and provides summary reports to legal for determinations.

• 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.

• Assists with the billing adjustments and write off determinations.

• 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.

• 18. 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.

• 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.

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

• Participates in after-hours and weekend Risk Management on-call rotation, as request

Colleagues of Saint Alphonsus Health System enjoy competitive compensation with a full benefits package and opportunity for growth throughout SAHS and Trinity Health.

 

Visit www.saintalphonsus.org/careers to learn more about the benefits, culture and career development opportunities available to you at Saint Alphonsus Health System.

 

Saint Alphonsu