GENERAL SUMMARY AND PURPOSE:
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.
SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:
Bachelor's degree required. Nurse license required.
Certified Professional in Healthcare Risk Management (CPHRM) preferred.
Three years of experience in healthcare.
ESSENTIAL FUNCTIONS:
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. 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. 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 managers/directors on patient dismissals/terminations. 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. Primary 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 SAHS Director of 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 Regional Director of Risk Management
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is 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, status as a protected veteran, or any other status protected by law.