SPECIALIST - RISK MANAGEMENT in CANTON, Ohio at Aultman Health Foundation

BRIEF SUMMARY OF THE POSITION

The primary purpose of the Risk Manager is to identify, evaluate and make recommendations of risks or potential risks related clinical practice, general liability, loss exposures and safety in in efficient, professional and cost-effective manner.

ESSENTIAL PHYSICAL/COGNITIVE JOB FUNCTIONS

Employees must be able to perform the essential functions of this position, with or without reasonable accommodation.

• Manage and coordinate data collection, entry and submission for CMS Section 111 reporting for hospital, employed physicians and captive insured physicians. Run queries and submit reports as required by regulations.
• Works closely with managers and vice presidents to provide prompt resolution of patient/family issues as indicated. Assists with decision to provide administrative adjustments and/or reimbursement.
• Identifies patient/family concerns with a quality of care issue and/or potential liability. Provides for appropriate referral to the Quality Department or other department/committee as appropriate. Investigates potential liability issues and document findings.
• Provides informational analysis by designing, producing and maintaining legal database reports for statistical data, patient concerns and compliments, losses, safety and other reports as needed.
• Assists Legal Counsel and Associate Legal Counsel in designing programs, policies and procedures.
• Analyzes data to determine trends and system problems.
• Reviews variance reports in a timely manner, evaluates and reports trends in variances to appropriate departments, committees, managers and executives.
• Provides orientation and continuing education to organization's staff regarding customer service, legal/risk issues and other topics as needed.
• Assists internal and external counsel to coordinate the investigation, processing, discovery, defense, and settlement of claims and suits against the organization. Notifies insurance carriers of potential and actual claims and such claims are entered and tracked in the claims management database.
• Investigates and manages general liability claims against the organization. All such claims are entered and tracked in the claims management database.
• Participates in the Risk Management Program to minimize the risk to the organization by: Maintaining current knowledge of policies, laws and regulations; serving as a resource to the organization's staff; review of patient deaths; maintaining insurance information and other proactive risk management activities.
• Screens subpoenas and assists staff in preparing for testimony and communicates with appropriate third parties. Reviews authorizations to release healthcare information as needed.
• Participates in various hospital committees; such as Forms Committee, Safety Subcommittee, Purchasing Advisory Committee, Magnet Board for Clinical Improvement, Magnet Practice/Education Council and other committees as needed.
• Maintains a professional relationship with patients, families, physicians, employees, and attorneys.
• Maintains confidentiality of information obtained during performing duties.
• Interacts with department staff for problem resolution and program development.
• The above statements reflect the general categories under which the role of the Risk Case Manager functions and should not be considered as a detailed description of the specific work requirements that are inherent in the position.

EDUCATIONAL/EXPERIENCE REQUIREMENTS

Minimum Education/Experience:

• Must be a RN with a BSN and current licensure to practice as a registered nurse; CPHRM Certification or actively pursuing.
• Minimum of five years of clinical experience.
• Demonstrates the ability to make decisions that are within the guidelines established by outside governing bodies and hospital policy.
• Demonstrates the ability to understand and utilize the mainframe systems and computer programs.
• Demonstrates the ability to appropriately handle frequent questions, problems and concerns in a courteous and professional manner.
• Demonstrates positive interpersonal communication and problem-solving skills with patients, families, physicians, employees and management.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, or veteran status.

JOB LOCATION AND SCHEDULING

• Normal hours are 8:00am - 4:30pm, Monday through Friday. No weekends or holidays. Other hours and shifts as required. On call rotation with the Director of Risk Management.
• Lunch periods and breaks are flexible with daily work flow.
• Subject to frequent interruptions and frequent change in priority of duties throughout the day.
• Handle multiple tasks simultaneously.
• No unusual physical activities or abilities required.
• Hazard exposure rating: 3

IMPORTANT NOTICE

This job description is intended to describe the general nature of the work performed. It does not contain a comprehensive inventory of all job duties, responsibilities, and qualifications. Employees will be required to perform any other job-related duties as requested by management. Aultman reserves the right to revise this job description. Employment with Aultman is at-will, meaning both Aultman and employees have the right to end the employment relationship at any time and for any reason. The at-will nature of this employment cannot be altered by and verbal statement or alleged verbal agreement. It may only be changed by a legally-binding written contract covering employment status. Aultman will reasonable accommodate employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on Aultman or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the Human Resource Department and request such an accommodation.