Registered Nurse Senior, Clinical Risk Management

We are recruiting for a motivated Registered Nurse Senior, Clinical Risk Management to join our team!

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Department
Risk Management

Job Summary

Under minimal supervision, the Senior RN Clinical Risk Manager is responsible for the clinical review and analysis of significant occurrences as related to risk management, quality, and patient safety. Provides clinical oversight and in the absence of the Director, provides management and leadership to the Risk Management Department.

Essential Functions
:

• Claims Management
  
  • Review notices of claim, summons and complaints.
  
  • Perform a detailed claim investigation.
  
  • Facilitate thorough quality review of claims with either outside reviewers or internal reviewers.
  
  • Present findings to the Risk Management Committee for disposition of claim recommendations.
  
  • In conjunction with the Director and General Counsel, recommends a course of action for litigated cases.
  
  • At the insurance company's request, provide an updated and clinical review of reported occurrences and keep them apprised of claim activity.
  
  • Maintain case files.
  
  • Confer directly with claimants, attorneys, physicians, employees, brokers, carriers, and consultants involved in the claim.
  
  • Assists with interrogatories, depositions, hearings, and trial preparation as necessary.
  
  • Values claim and assists in settlement negotiations through retained attorneys, mediation or directly with claimant.
  
  • Act as a resource and liaison for individuals named in a NOC or Summons and Complaint.
  (40%)
• Management of reportable occurrences
  
  • In collaboration with the Risk Management Director and the department of Patient Safety and Quality, determine whether the occurrence meets the elements for a state reportable event to Colorado Department of Public Health and Environment (CDPHE).
  
  • Facilitate a thorough review of the occurrence via interviews, chart audits and supporting documentation.
  
  • Submit final findings to CDPHE along with proposed corrective action items, if applicable.
  (20%)
• Educational Services
  
  • Provide Risk Management orientation and training for nurses, managers, providers, and others who may be subject to litigation, or as requested.
  
  • Attend and participate in Morbidity and Mortality (M&M) reviews and department Quality reviews to evaluate discussed cases and assess for significant risk or liability potential.
  
  • Serve as an active member on risk management/patient safety/quality related committees.
  (10%)
• Management of Sentinel Events
  
  • In conjunction with the Director, determine if significant occurrences meet the Joint Commission criteria for being considered a sentinel event or near miss.
  
  • Oversee the Root Cause Analysis (RCA) process.
  
  • Present the RCA and proposed risk reduction strategies to the appropriate audience.
  (10%)
• Clinical Review of Occurrences
  
  • When alerted to an occurrence, evaluate the medical practice in relation to professional standards, statutes, regulations, hospital and departmental policies and the standard of care.
  (10%)
• Working with State and Federal Agencies
  
  • Assist with CDPHE, Joint Commission and CMS surveys.
  
  • Maintain appropriate records to provide documentation and follow-up as requested.
  
  • Contact and work with other agencies when necessary, such as Denver Police, if it appears a crime has been committed.
  
  • Acts as a back-up for the processing of subpoenas when the Legal Secretary is unavailable.
  (5%)
• Interact with defense and claimant attorneys, insurance carriers, brokers and adjusters
  
  • Promotes positive interpersonal (customer) relationships with fellow employees, physicians, patients and visitors. Treats these individuals with courtesy, dignity, empathy and respect; consistently displays courteous and respectful verbal and non-verbal communications.
  
  • Adheres to, complies with and demonstrates support for the mission and values of Denver Health. Supports and adheres to the Denver Health Values of Trust, Respect and Excellence.
  
  • Ensures…