Washington, DC, United States
Essential Duties and Responsibilities include the following. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Other duties may be assigned.Develop, oversee, and implement a comprehensive organizational Risk Management Plan that is designed to reduce or eliminate, when feasible, risk to organizational resources and to patients, families and staff with a focus on professional healthcare and general liability.Provide and/or arrange for education and training to organizational providers and staff regarding organizational risks and risk management strategies.Prepare, implement, and oversee an audit and monitoring program to assess ongoing effectiveness of risk management strategies.Responsible for managing potential or actual claims against the organization, including oversight of any third party claims administrator. Responsible for reporting patient care related incidents to appropriate insurance carriers.Provide risk management advice to minimize exposure to actions, claims, or suits, or evaluate practices and organizational policies to ensure consistent application of laws, regulations and/or accreditation standards.In collaboration with General Counsel and Finance, oversees organization's insurance programs, including the organization's captive insurance program. Based on risk assessment, provides advice to the organization regarding appropriate insurance coverage, and amounts.Assists in the development and/or revision of policies, procedures, and forms pertaining to patient care and administrative matters by reviewing and recommending revisions to conform to legal, regulatory, and/or accreditation standards and requirements.Conducts research and analysis into a variety of risk management issues. Prepares reports, opinions, correspondence, and other documents. Able to conduct and/or coordinate complex investigations of incidents involving actual, or potential, injury to patients, employees and visitors that could lead to financial loss, including professional, general, and employment practices liability. Analyze information, draw conclusions and provide advice or make recommendations regarding course of action and/or minimize risk. Ensure collection of all information necessary to prepare for defense of claims or other actions.Supervises the Risk Management Specialist(s) and delegates assignments appropriately.Provides oversight to the Patient Relations activities and the Medical Records Department. Ensures patient complaints are managed in a consistent, timely, and effective manner. Ensures medical records are maintained and released according to HIPAA/HITECH, applicable District or state law, and other applicable laws, regulations and standards.Maintains the highest levels of confidentiality and privilege afforded to each situation.Reviews contracts from insurance and risk perspective.QualificationsThe requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education For Insurance and Risk Management: Clinical healthcare, risk management and insurance claims management experience required. Law degree and/or Nursing degree preferred. (Other clinical licensure and experience will be considered)Experience 10 years of Risk Management experience in a hospital or ambulatory care medical office setting.Supervisory experience.Experience investigating and managing complaints, incidents, occurrences, adverse events, claims and/or medical malpractice litigation.Outstanding ability to deliver information effectively and professionally via multiple vehicles including verbal and non-verbal communication, one-on-one meetings, team settings, telephone conversations, letters, reports, and/or electronic messages.Demonstrated excellence in working with physicians and staff in a highly professional manner.Advanced skill in Microsoft Word.Above average skill in Microsoft Excel and other spreadsheet/report formats.Ability to prioritize and manage multiple and occasionally conflicting projects and deliverables.Competencies Must have excellent verbal and written communication skills. Must be able to communicate providing verbal feedback in a professional manner. Must be able to follow and understand instructions, and react favorably in all work situations. Must have strong interpersonal skills and be mentally adaptable and flexible in dealing with a variety of people at various levels within and outside the Medical Faculty Associates (MFA). Must be able to do math calculations and input data into the computer.