Under the direction of the System Director - Enterprise Risk & Insurance Management implements and maintains the risk management program for the Health First enterprise (4 hospitals, Medical Group, Outpatient Services, Health Plan) ensuring effective loss prevention/control and compliance with:
State and federal guidelines;
Health First’s service standards; and
Organizational and strategic priorities.
The clinical risk manager is primarily accountable for administering Health First’s risk management program on a day-to-day basis, documenting, managing and analyzing risk management data, conducting proactive risk assessments, providing targeted risk management education, and providing risk management consultation with the objective of promoting patient safety and loss prevention activity to protect organizational assets.
The primary accountabilities listed are examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Employees may also perform other relevant duties as assigned and in accordance with Health First’s service standards and organizational and strategic priorities:
No Harm / Quality; and
Customer experience and stewardship.
Primary Accountabilities:
Engagement:
Promotes the field of risk management and encourages department associates to seek continuing education so that they remain the industry experts.
Consistently demonstrates and lives out the I-CARE values of Health First in all work- related activities.
Reaches across the spectrum to work collaboratively with members of the medical staff, administration, patients, visitors, vendors, and regulatory agency personnel to comply with legal and regulatory requirements in a way that is transparent, honest, and respectful.
Quality/No Harm:
Complies with all internal risk management program requirements pursuant to Florida Statute, Title XXIX, Public Health §395.0197 and Title XXXVII, Insurance, §641.55
Monitors incident reporting system for injuries and adverse incidents.
Monitor the investigations of adverse events resulting in patient injuries at the direction of General Counsel for the purpose of seeking legal advice and assisting General Counsel with fact finding that is critical to assessing general and professional liability.
Acts as a conduit between the Office of General Counsel and Health First physicians and staff regarding liability issues.
Follows the ISO 31000 risk management process: identification, assessment, evaluation, mitigation and monitoring.
Maintains awareness of internal and external factors (ex: new legislation and regulations) that may affect Health First’s risk management program and communicates relevant findings to the appropriate departments.
Assists with the development of reports for leadership and the Board of Trustees regarding risk trends and findings analyzed from risk sources, such as incident reports and patient grievances.
Provides risk management education and consultation to all clients and stakeholders on topics, including but not limited to informed consent, disclosure of unanticipated/adverse events, medical marijuana, and termination of the patient-physician relationship.
Writes and reviews administrative policies and procedures that fall within Risk Management’s purview.
Remains available as scheduled for risk management on-call service 24 hours a day, 7 days a week.
Oversees FDA medical device reporting where devices have caused or have the potential to cause significant harm or death.
Participates in established hospital quality and patient safety oversight committees.
Develops innovative approaches intended to reduce the frequency and severity of medical malpractice and patient injury claims.
Routinely identifies risk through review of medical staff peer review issues, patient/family grievances, committee minutes, third party reports, attorney requests for medical records and administrative or associate referrals.
Acts as a liaison between Health First and the Patient Safety Organization in which Health First participates.
Assures submission of special category incident reporting (ex: Annual reports of incidents causing patient injury and Code 15 reports to the Agency for Health Care Administration within 15 days of the occurrence or respectively, in accordance with Florida Administrative Code 59-A10 and State Statute 395.0197).
Timely documents cases of liability (potential and actual) into the Claims application.
Work collaboratively with the General Counsel, providing input and assistance with performance improvement activities and support the legal department with ongoing litigation and claims.
Stewardship:
Achieves financial goals established for risk management department.
Identifies and implements ways to reduce present and future costs and expenses without sacrificing quality or customer satisfaction.
Promote the containment of claims and losses.
Authority to settle hospital claims in an amount not exceed $5,000.
Customer Experience:
Oversees the management of complaints and grievances in a manner that expresses concern and caring for those who were provided services that did not meet their expectations.
Serves as a resource for our medical, nursing, and allied health staff for compliance with regulatory requirements and in the area of risk reduction and elimination.
Supports and encourages a service atmosphere through routine communication and collaboration with key partners, including but not limited to the Office of General Counsel, Quality, Compliance, Medical Staff, Nursing, etc.
Qualifications
QUALIFICATIONS REQUIRED:
Bachelor's degree in a work-related discipline/field from an accredited college or university, nursing/clinical background required. Three (3) years related healthcare risk management experience as position of Risk Manager or with primary responsibility for risk management or patient safety activities in an acute care hospital, licensed health care facility, medical group or health insurer. CPHRM required or obtained within approximately 2 years.
Excellent organizational skills
Ability to handle high stress areas
Excellent oral and written communication skills
Ability to foster effective working relationships and build consensus
Proficient computer skills (ex: PowerPoint, Excel, extracting data and reports)
Continuous and consistent utilization of the ISO 31000 risk management process
Knowledge of Health First’s strategic and organizational goals
Ability to Maintain confidentially in all areas
Ability to Mediate and resolve complex problems and issues
Ability to Motivate and influence others
Ability to Research, write and present effectively on risk management topics and trends
PHYSICAL DEMANDS:
Work involves walking rounds to all areas of hospital.
Must be able to stand, walk, bend and stoop for up to 8 hours, generally with 2 short breaks.
Visual acuity and hand-eye coordination to perform computer tasks.
Ability to lift up to 40 pounds unassisted, 2-3 times per day.
MENTAL DEMANDS:
Ability to work in often stressful environments.
Ability to exercise excellent judgment in difficult situations.
Ability to immediately assess potential liable situations and react appropriately.
Excellent negotiating skills.
COMPETENCY ASSESSMENT/SKILLS CHECKLIST:
Maintains courteous, tactful and professional level of interpersonal skills necessary to deal with associates, medical staff, patients, co-workers and public.
Able to report and convey required information both verbally and in writing.
Maintains required level of confidentially.
Consults with and/or advises appropriate personnel of situations requiring follow-up or attention.
Analyzes data from incident reports and identifies trends.
Assures follow-up on incidents as needed.
Meets all statutory requirements for hospital risk management programs.
Health First is Central Florida's only fully integrated health system. With a mission to positively change the health and wellness of the communities we serve, Health First offers the latest technological advances and quality care at our four hospitals and through our many Outpatient & Wellness Services, as well as the area's only Trauma and Heart Centers. Health First also offers multiple commercial and Medicare health plans, the largest multi-specialty physician group in Brevard County, and four fitness centers to help members of our community stay healthy.
