Director, Risk Management (Bakersfield)

About the role

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Responsibilities

• Identifying, examining and responding to risk-related issues and complaints involving the organization and its affiliates;
• Managing or assisting in risk related reviews to prevent financial loss, improve safety, and ensure compliance;
• Collaborating and consulting on grievances, complaints, or concerns that have risk management implications;
• Making recommendations and implementing solutions and resolutions to risk-related issues and events;
• Following up on the implementation and impact of proposed solutions and resolutions;
• Coordinating communication, disclosure, and early resolution after a safety event;
• Having a general knowledge of organizational insurance programs and resources and supporting Claims team in managing the organization's insurance program;
• Interfacing with internal and external legal defense counsel.

Requirements

• Education and Work Experience: Bachelor's degree in Nursing or other clinical field, risk management, legal or other related field: Required Master's degree: Preferred Seven years' experience in healthcare or general risk management: Preferred Five years' leadership experience: Preferred
• Licenses/Certifications: Certified Professional in Healthcare Risk Management: within two (2) years of hire

Qualifications

Essential Functions:

• Has oversight of Risk reviews of events and complaints that pose organizational risk and assists in appropriate responses.
• Participates in patient safety event review meetings and conduct necessary follow up.
• Directs and ensures efficient and adequate review analysis, and follow up are completed for high harm and potential compensable events (PCEs).
• Analyzes event reporting data and makes recommendations for future review action.
• Contributes and participates in activities designed to reduce risk exposure and improve safe patient care (e.g. Cause Analysis, Failure Mode Effects Analysis (FMEA) and performance improvement teams).
• Facilitates risk assessments as needed to proactively identify and evaluate areas of risk.
• Acts as a liaison and resource to market Risk Management to assess risk exposures in specific clinical and other situations (e.g. Facilities, Safety, Nursing, Pharmacy, Security, and Patient Relations).
• Oversees reporting requirement of medical device and equipment failures.
• Participates as member of various organizational councils/committees to provide risk management perspective and input for purposes of managing organizational risk and promoting safety activities.
• Analyzes and monitors claims trends and develops risk mitigation activities and solutions in conjunction with market Risk Management, Claims team, and Legal department.
• Manages claims process and ensures timely production and submission to internal and external legal counsels.
• Coordinates with Claims team and internal and external legal counsel to successfully manage, mitigate, and resolve claims.
• Oversees collection and dissemination of confidential claims information and data to authorized individuals.
• Oversees and reviews periodic risk management claims reports as needed.
• Coordinates the timely and accurate response to inquiries for claims history and coverage information.
• Maintains evidence preservation (e.g. surveillance video, equipment, etc, and/or litigation holds).
• Attends trial as site representative as directed by internal and external legal counsels.
• Recommends payment for replacement of lost property after claims evaluation.
• In collaboration with Claims team and internal and external legal counsels, negotiates settlement of small claims within administrative authority and advises billing department of appropriate action for unpaid accounts involved in litigation.
• Safeguards documents obtained or developed for cause analysis to ensure documents/proceedings are protected from discovery.
• Develops risk management program, policies and procedures and enhances existing risk management programs, policies, and procedures consistent with established organizational philosophies and values.
• Collaborates with various departments to analyze data (e.g. complaints, grievances, claims, lawsuits) to identify priority topics and audiences for targeted training and education.
• Utilizes external data (local, state, national) to identify high-risk topic areas and focus groups for targeted education.
• Offers risk educational program on a regular basis and as requested including organization-wide presentations as well as specialty specific.
• Performs other job-related duties as assigned.

Skills

Collaborates with various departments to analyze data (e.g. complaints, grievances, claims, lawsuits) to identify priority topics and audiences for targeted training and education.

Benefits

The estimated base pay for this position is $132,384 to $198,577. Additional individual compensation may be available for this role through differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package, and a comprehensive benefits program is available for qualifying positions. Please contact our Talent Acquisition team for more information.

Pay

The estimated base pay for this position is $132,384 to $198,577.

Schedule

Shift Length: 8 Hours