Sutter Health Affiliate Risk Specialist - Surgery Center, San Carlos (Full Time, Days) in San Carlos, California

Description

Job Summary:

The Affiliate Risk Specialist II is accountable to the Affiliate Risk Officer and is responsible for specific aspects of the risk management program with an emphasis on loss prevention and reduction in multi-disciplinary settings. Participate in the development, implementation, monitoring and evaluation of the systems, programs and policies designed to reduce or eliminate loss exposure. Serve as a primary investigator in conducting investigations of clinical and non-clinical patient safety reports; investigate and provide follow-up to the departments as appropriate and identify those events which qualify as potentially compensable events. Maintain documentation in the appropriate tracking system of risk mitigation. Use critical thinking skills to identify basic risk issues and apply those concepts to a variety of situations. Work independently and collaboratively to provide a risk management approach to risk prevention. Perform additional projects as assigned. Interface with affiliate leadership, physicians, and the Healthcare Risk team. The Affiliate Risk Specialist II reports directly to the Affiliate Risk Officer.

Responsibilities:

Risk Management Program Development

  • Facilitate the implementation of a pro-active, patient safety focused, risk management and loss prevention programs as assigned

  • Document and lead investigation of patient safety reports (e.g.: IR’s, QAR’s RDE’s)

  • Facilitate risk management consultative services to affiliate leadership

  • Independently investigate, provide analysis, follow-up, and identify potentially compensable events

  • Complete appropriate reporting forms on each potentially compensable event and forward to the appropriate entity

  • Provide support and guidance to affiliate in meeting captive insurance company incentive program

  • Oversee the Patient Safety Evaluation System, as defined by policy

  • Prepare and coordinate responses to external agencies relative to concerns about patient safety or quality of care

  • Represent the risk management program with responses to inquiries from government bodies, health and safety agencies, insurance companies, and legal counsel

  • In collaboration with the Affiliate Risk Officer, provide oversight for affiliate implementation of risk mitigation, case law mandates and regulatory requirements

Claims Management Processes

  • Manage effective claim and litigation management processes the affiliate is using in order to ensure the management process is implemented effectively, consulting with Risk Officer as appropriate

  • Facilitate in-depth medical chart review and analysis of reported events

  • Complete confidential reports on potential compensatory events and submit timely reports to SISCO and other insurers, as appropriate

  • Has authority to make a determination regarding billing adjustments (per system Billing Adjustment policy) such as placing bill on hold or waiving bill up to amounts as set by Risk Officer

  • Responsible for organized and complete management of claims files

  • Ensure retention of claim files, as per retention policy and legal hold requirements

  • Work collaboratively with third party administrators and other insurers to prepare and monitor claims, as per policy and procedure

  • Maintain attorney client privilege in the management of high risk events and litigation

Risk Assessment and Guidance

  • Independently identify and assess existing and potential affiliate risk exposure by conducting risk assessments and following up with department managers, directors and leaders, e.g., tracking/trending/analysis of risk data

  • Use critical thinking skills to identify basic risk issues and apply those concepts to a variety of situations, e.g., authority to interpret and CHA Consent Law Manual and consult on consent issues

  • Authority to lead in-depth reviews of high-risk practices and affiliate compliance with legislative, legal and regulatory standards through proactive process improvement, including, Lean, FMEA’s, RCA’s, etc

  • Monitor high risk events and affiliate programs to measure progress towards resolution of potential loss exposure, in collaboration with Risk Officer

  • Develop clear and concise documentation of risk issues addressed and/or resolved

  • Has authority to formulate, affect, interpret, or implement risk management related policies, e.g., Billing Adjustment policy, Sentinel Event reporting policy.

  • Provide consultation and mentoring to Risk Specialist I

Risk Education

  • Contribute to educational/orientation programs on risk management, patient safety, and loss prevention for staff and leaders

  • Participate in various risk management seminars for system-wide learning

  • Serve as a resource to staff and departments for identified educational needs and issues specific to risk initiatives

Qualifications

Required: Associates Healthcare or Business Administration related field. Travel on a regular basis, must have reliable transportation.

Bachelors preferred. Associate in Risk Management (ARM); Clinical License highly preferred; Certified Professional in Healthcare Risk Management (CPHRM) highly preferred.

Experience required:

  • Demonstrated experience in healthcare services/administration, as typically acquired during 3-5 years in a similar position

  • At least one (1) year of experience managing healthcare-related liability claims, loss exposure, and risk reduction, preferably in a healthcare setting

  • Demonstrated experience assisting in the development, implementation, and monitoring of healthcare related programs

  • Previous experience conducting analyses to identify behavior issues that could result in increased liability exposure

  • Demonstrated skills in various data management software (Excel, Word, Worldox, Midas, etc)

  • General knowledge of healthcare-related state and federal laws and regulations

  • General knowledge of accreditation and professional standards within the healthcare industry

  • Working knowledge of investigative tools and resources used to complete risk exposure assessments

  • Practical knowledge of principles and methods used for curriculum building and training design

  • General understanding of risk management best practices and methods used to limit exposure liability and risk

Primary Location: California, Peninsula/South Bay and Santa Cruz, San Carlos

Organization: Palo Alto Medical Foundation

Employee Status: Regular

Benefits: Yes

Position Status: Exempt

Union: No

Job Shift: Day

Shift Hours: 8 Hour Shift

Days of the Week Scheduled: Monday-Friday

Weekend Requirements: None

Schedule: Full Time

Hrs Per 2wk Pay Period: 80

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.