Clinical Risk Manager

Overview

The Clinical Risk Manager is to ultimately provide a safer hospital and clinic environment by mitigating or reducing risks for all individuals within the organization. Serves as a resource for all colleagues and providers on medical/legal concerns. Investigates Event Reports and EMTALA related concerns and identifies major trending patterns.

Hybrid. Traditional day time hours. The Clinical Risk Manager's office could be located in either Baker City or Ontario, Oregon. Rotating call coverage for one week, to be performed via telephone.

• Must have active RN license; BSN preferred.
• Certified Professional in Healthcare Risk Management (CPHRM) preferred.
• 3 years of nursing experience in a clinical role that gives exposure to Risk and process improvement required.

• Knows, understands, incorporates, and demonstrates the Organization s Mission, Vision, and Values in behaviors, practices, and decisions.
• Must have the ability to work under pressure with time constraints, including presenting to all associates in a respectful and professional manner as part of SAH s Core Values. Participates in daily Safety Huddles and provides reports for the department and support for other departments as needed.
• Assists in the oversight and maintenance of the system-wide Event reporting system.
• Analyzes Event reports to determine causes and to suggest remedial actions. Reassign events to appropriate department/clinic leadership and/or to peer review.
• Ascertain clinical course of patient event from documentation and demonstrate knowledge of regular processes pertaining to nursing care, departmental/clinic functions, etc.
• In collaboration with the AOC, Clinical Coordinators, or applicable department/clinic leadership, determines and coordinates initiation, leading, and follow up of CERT’s and Root Cause Analysis (RCA) processes. Expert in Apparent Cause Analysis (ACA) processes and can lead and/or provide guidance and education as needed.
• Oversees and tracks the implementation of corrective action plans resulting from the CERT’s, ACA’s and RCA’s process as needed.
• Notifies TH insurance of all actual and potential adverse events, SRE’s, SSE’s and/or potential compensable events.
• Works with legal department to conduct EMTALA investigations and provides summary reports to legal for determinations on a case-by-case basis.
• Serves as a liaison with Patient Relations or office manager/director if the patient grievance is elevated.
• Works with providers and/or group managers/directors on patient dismissals/terminations.
• Assists with the billing adjustments and write off determinations, and Patient Accounts Review Team.
• Is the contact and local support for claims processing related to general or professional liability.
• Interacts with claims management in the system office, local attorneys, and external defense attorneys. Processes requests for interrogatory or requests for production materials and provides it to defense attorneys per their request.
• Conducts pro-active Risk Assessment to identify, evaluate and develop action plans.
• Collaborates with Performance Improvement and Patient Safety in all serious adverse events and the associated corrective action plans.
• Collects, evaluates, and distributes relevant data related to Events, SRE’s, SSEs, and claims that may include aggregate data, summaries, monthly/annual trend analyses.
• Prepares or provides materials for reports for applicable committees, the medical staff, and the governing board.
• Participates in hospital or medical group committees/teams and/or Boards as requested.
• Provides education for colleagues and providers on risk management related topics. Provides New Hire Orientation and/or annual educational information regarding Event reporting processes and other risk management related topics.
• Maintains awareness of legislative and regulatory activities related to health care risk management.
• Assists the Manager, Safety and Risk Management and other Risk Management staff in the triage and assessment of day-to-day risk management needs to include supporting Baker City, Nampa and the Boise Regional Medical Centers.
• Participates in after-hours and…