Risk Management Specialist

Major Responsibilities

• Supports the adverse event reporting process (patient, visitor, public safety & facility related) via the Risk Management database, and the investigation of those adverse events to improve quality of patient care & health outcomes, promote safety and reduce of liability exposures.
  • Follows the process for reporting and review of events as in compliance with Advocate Policy. Reviews all submitted event reports. Identifies events that require claims notification and referral for further quality or peer review to Patient Safety, Quality and/or Peer Review Committees in coordination with the Manager.
  • Provides education and training to all associates, and physicians on use of the electronic event reporting system and routinely as changes and updates occur.
  • Analyzes the risk data received through event forms, anonymous reporting, telephone referrals and personal contacts. Makes corrections of event form data elements in the database for accurate, complete and consistent information.
  • Notifies Manager, Director and/or Administrator of significant serious events and may participate in the activation of the Serious Safety Event Response team.
  • Creates and generates event summary reports that identify trends, analysis, liability exposures for committees, departments/units and managers.
  • Assists in tracking medical device and equipment recalls and reviews site response plan. Adheres to the processes to sequester and maintains chain of custody of supplies, equipment & devices involved in adverse events and reports to FDA Med Watch when required.
  • Collaborates with Public Safety and Security department to identify risk and safety exposures to the Site, patients, visitors and associates and makes sure that safety and security incidents are appropriately reported and investigated. Responds to specific emergency codes at the site as appropriate.
• Performs the Claims Management and Insurance responsibilities of the Risk Management Department in compliance with Advocate policy. Supports defense legal counsel and claims administrators in the investigation and management of claims.
  • Identifies and reports to Claims Administrator incidents, accidents and events that could lead to financial loss, including professional and general liability (non-asserted claims). Conducts the investigations and follow-up, including medical record summaries, Interviewing involved staff, resident or physician and reviewing key documents. Adheres to procedures that protect sensitive and financially damaging information from inappropriate disclosure.
  • Works with non-Hospital risk management departments and the assigned claims administrators, to coordinate claims investigation and reporting for an physicians or clinicians covered by the self- insured trust at the Hospital.
  • Attends court during pretrial and trial situations as a site representative as assigned.
  • Timely reports all non-asserted, asserted, attorney liens and lawsuits to Advocate Insurance Segregated Portfolio Company (AISPC) through the Claims Administrator including the completion of all required documents and forms within the designated timeframe.
  • Adheres to requirements under CMS section 111
    - Mandatory Insurer Reporting and claims management guidelines.
  • Collects information and documents necessary to prepare for the defense of claims and lawsuits. Assists defense legal counsel in accessing the site records, associates, and physicians as appropriate, during the discovery process of cases in litigation. Arranges and schedules attorney interviews and depositions for defendant associates and physicians.
  • Assists Manager in collecting site and physician exposure data for the completion of the annual professional liability insurance renewal submission.
  • Assists Manager, Claims administrator and/or Legal in responding to non professional liability subpoenas or court orders. Evaluate attorney request for records to identify potential claims.
• Responsible for daily activities within the site Risk Management program through event review, risk identification, loss prevention, claims management to improve the quality of patient care, reduce risk, and minimize potential loss in…