The Risk Program Manager collaborates with senior leaders and key stakeholders or experts, (e.g., Clinical Operations, Patient Safety, Supply Chain, Legal, and Regulatory Services), throughout PCH to develop system-wide responses to risk issues that impact specific groups or the entire organization with policies/procedures, guidelines, tools, forms, and education/training. In addition, this position serves as a liaison between patients, families, and all hospital departments, facilitating conflict management and complaint resolution to achieve optimal communication between patients and healthcare team.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
I. Develops risk mitigation strategies based on analysis of relevant data (e.g. claims, complaints/grievances, Serious Reportable Events, and risk assessments). Investigates and analyzes potential and actual professional liability exposures in the organization; evaluate the extent and elements of exposure and recommend appropriate actions for risk mitigation
- a.Works in conjunction with the Quality Management and operational leaders in the investigation of potential or actual events/concerns. Participates in root cause analysis (RCA), Failure Mode and Effects Analysis (FMEA), or risk mitigation and investigation strategies.
- b.Supports the Risk Management and Quality Management teams in error prevention efforts by investigating and analyzing events and trends, and communicates findings to appropriate departments/staff.
- c.Develops processes and benchmarks to monitor the effectiveness of risk mitigation strategies.
- d.Collaborates with Risk Management and Quality Management staff in developing periodic in-services, teleconferences, face-to face meetings and work groups regarding health care risk management and related topics.
- e.Performs risk assessments and audits in various clinical settings and coordinates development of clinical loss prevention plans for PCH based on event or claims analysis. Assumes an active role in on-boarding newly acquired practices and mitigating potential liabilities using risk assessment tools.
- f.Assists Quality Management in gathering information requested by regulatory agencies, in regards to complaints/grievances, and event investigations. Assists Quality Management in the identification of policies/procedures, and other information that identifies and supports organizational efforts in response to regulatory investigations.
II. Under the direction of Risk Management Leadership and PCH Counsel, investigate and analyze potential and actual professional liability exposures in the organization; evaluate the extent and elements of exposure and recommend appropriate actions for risk mitigation.
- a. Ensures the quality of legal services for HPL lawsuits and the efficient use of funds
- allocated for legal expenses by directing the activities of outside defense counsel,
- performing internal audits of defense legal services and continually evaluating
- strategic alternatives and opportunities for early mediation/resolution of claims and
- b. Serves as a liaison between Counsel, other business units and external contacts to
- coordinate and expedite legal matters to ensure discovery and other related documents
- are prepared and executed accurately and in a timely manner. Coordinates activities
- related to meetings, depositions, mediations, and other legal activities and ensures the
- litigation calendar is up to date.
- c. In conjunction with the Risk Management Director, will keep PCH Risk Management Leadership and General Counsel regularly apprised of all significant developments in claims and litigation matters. Such leaders shall be consulted sufficiently in advance of the date by which any significant decision must be made regarding a particular matter. This includes obtaining settlement authority and discussing any other discovery or public relations topics.
- d. Collaborates in the completion of notifications and financial recommendations needed for compliance with tracking and insurer requirements, including excess insurance carrier notifications, reserve recommendations, and any federal, state, or entity reporting requirements (including SMDA, MMSEA Section 111, DataBank, etc.) as necessary.
- e. Provides oversight and maintains the accuracy and integrity of documentation in the Risk Management System (RMIS). Ensures that the claims/litigation files and other documentation are organized, clear, concise, and timely updated.
Works with clinical leaders to manage complex or unresolved complaints and grievances.
- a.Researches medical records, policies and procedures to gather information required for the resolution of complaints/grievances.
- b.Supports operational leaders in implementing and sustaining patient experience improvement initiatives. Is a key partner is supporting the culture of patient and family centered care.
- c.Initiates rounding on patients and staff and prioritizes focused re-visits to improve the patient and family experience.
- d.Works with clinical leaders to ensure a written response to grievances in accordance with applicable policies and regulations.
- IV. Provides on-call assistance for emergent/urgent risk management issues.
- Performs miscellaneous job related duties as requested.