Clinical Risk Manager

Job Description Summary

Under the leadership of the Senior Clinical Risk Manager, the Clinical Risk Manager contributes to the day-to-day operations, management and advancement of South Shore Health’s Risk Management Program. This includes participating in proactive, system-wide risk identification, investigation, mitigation and risk reduction activities. The South Shore Health (SSH) Clinical Risk Manager serves as a subject matter expert providing risk management consultation and support to providers and staff as needed.

Under the direction of the Senior Clinical Risk Manager, the Clinical Risk Manager submits reports to external agencies ensuring compliance with regulatory requirements. Support the day to day coordination and function of the Risk Prevention/Patient Safety Department, as appropriate.

• Participates in planning, implementing, managing, monitoring, and documenting an integrated, comprehensive and proactive risk management program for SSH.
• Collaborates with Patient Safety, Regulatory/Accreditation, Compliance, Quality Management, Office of Patient Experience and departmental quality and operations leaders to identify and assess unusual incidents, unexpected outcomes, and potential risks, translating learnings into the development of loss and error prevention strategies.
• Serves as internal consultant and facilitator for quality improvement committees and teams
• Recommends corrective and preventive actions to reduce risk. Collaborates with insurer and hospital-based improvement teams on interventions.
• Reviews and evaluates aggregate adverse events and claims data, as well as other hospital information in order to identify high-risk activities, procedures and departments.
• Performs root cause analysis on all serious reportable events (SREs) and other events as appropriate. Supports staff in investigation/review process, debriefs, corrective actions and follow-up. Completes required reporting and documentation in accordance with legal, regulatory, accreditation standards and requirements.
• As requested, serves as institutional liaison to professional/general liability insurers.
• Ensures appropriate and timely communications with health system and departmental leadership concerning professional/general liability matters.
• Under the direction of the Executive Director of Risk, Senior Clinical Risk Manager and the Office of General Counsel, assists in the claims management process for the hospital including directing management of legal claims involving hospital and staff and collaborates with insurers, as needed.
• Assists with supporting and coordinating Medical Staff Peer Review Committees, working closely with Medical Staff leadership, providing accurate clinical summaries, data trending, reports and analysis.
• Collaborates with the Patient Experience Department to assist in reviewing patient grievances. Works with team, as appropriate to respond to patient grievances.
• Partners with colleagues across the organization to coordinate and facilitate risk and safety education, complete collaborative risk reviews, and develop robust action plans.
• Integrates risk management program activities with clinical programs, hospital and health system operations and administration, such as patient safety, regulatory/accreditation compliance, patient care services, environmental safety, human resources, infection control, occupational health, clinical laboratories, physician services, information management, compliance/privacy, etc.
• Participates on the Quality Council, Joint Commission Core Team, Environment of Care Committee, and other committees, as need is identified.
• Development of institutional communication and education strategies related to Risk Management, quality and patient safety issues and compliance with emerging regulatory, case and statutory law.
• Participates in on-call schedule to enable 24/7 coverage for inquiries on risk management matters.

• Performs comprehensive system analysis of patient safety events utilizing just culture principles and standard processes. Focuses on high reliability concepts when developing improvement initiatives.
• Reviews adverse event reports to ensure timely and appropriate analysis and follow up.
• Performs data analysis of safety event reporting relative to adverse incidents to identify trends, and signals of risk.
• Plays vital role in the management of risk /safety reporting systems, including but not limited to file management, user set-up and training, and reporting.

• Serves as internal consultant to the health system departments and leaders on matters of regulatory compliance and other health care related regulations, laws, and standards. Appropriately involves SSH Office of the General Counsel and Compliance & Privacy Department as needed.
• Maintains current and accurate knowledge of regulations, laws and standards pertaining to SSH, including but not limited to FDA, TJC, DPH, and CMS Medicare Conditions of…