Risk Program Manager

Responsibilities

• Serve as a risk management advisor and expert; provide justification for decisions using data combined with a deep understanding and knowledge of risk management at UnityPoint.
• Offer guidance and assist the risk managers and others on several workstreams as well as provide leadership to influence complex risk management decisions.
• Consult, advise, and lead multiple health system diverse strategic initiatives, including defining the scope and work plan, managing execution across deliverable design and development, coordinating resources, and aligning with key stakeholders.
• Assist in the development, implementation, and maintenance of structures and processes which support risk management and patient safety.
• Provide guidance on risk mitigation strategies, contract formation and contract management.
• Facilitate the collection, storage, and analysis of loss control, improvement, and safety data.
• Identify key performance indicators (KPIs) and key risk indicators (KRIs) for data collection, analysis and monitoring of activities to demonstrate reduction in risk and claims for UPH.
• Report on KPIs, KRIs and other loss control/claims data to UPH leadership on a regular basis.
• Investigate and develop risk reduction/loss control strategies from claims data.
• Initiate planning and development of risk management and loss prevention education for all departments & care providers.
• Establish and maintain communication between Risk Management and key areas throughout the Market and UPH Health System.
• Utilize all available data sources, identify enterprise-wide loss drivers and develops systems, processes, and practices to improve patient safety and limit liability exposure.
• Provide risk management consultation and advice to executives, physicians, care providers and employees and maintains knowledge of current healthcare-related risk management trends and issues.
• Collaborate with UPH Legal, the Third-Party Administrator, commercial insurance carriers and defense counsel in supporting the litigation process.
• Complete and report potential liability issues and claims internally as well as to UPH, the Third-Party Administrator, and any other commercial insurers as indicated using claim reporting guidelines established by UPH legal and any commercial insurer as directed.
• Absorb and evaluate claims and develop risk reduction strategies.
• Collaborate with claimants, legal, senior leadership and other colleagues to evaluate and when indicated, negotiate asserted claims to resolution.
• Inspire, coach and lead team members, fostering individual and team growth through delegation, feedback, instruction, and encouragement building on developing areas of improvement.
• Assists senior leaders, Directors, Managers and other team members in using the Event Reporting computer system.
• Lead and organize disclosure teams for adverse outcomes when appropriate for disclosure.
• Create and disseminate quarterly Risk Analysis and Summary report.
• Continuously research and find opportunities for advancement of expanding current knowledge for multiple areas of expertise.
• Develop and implement new programs, processes, standards, or operational plans that will impact UnityPoint enterprise wide.
• Review and make recommendations to continuously improve, expand and create efficiencies in current programs and practices.
• Synthesize high-level of information into action items, programs, or initiatives.
• Serve as member of Critical Events Committee (CEC), safety, mortality/morbidity, and other committees that would benefit from risk management representation.
• Review all Event Reports to screen for potential liability and appropriate follow-up.
• Provide documentation on Event Reports which require follow-up/action for Risk Management.
• Works with departments to ensure timely follow-up of Event Reports.
• Lead or contribute to investigation of event (to include staff interviews, review of records for timeline development, verification of policy/procedure compliance or variance).
• Support Patient Relations with Complaint and Grievance responses specific to harm (and potential for liability).
• Investigate potential compensable events as directed by Director or UPH Legal, which may include interviews of medical staff, employees, visitors, and patients, and assesses potential liability.
• Identify potential loss conditions and practices and evaluates their significance.
• Reports findings and devises remedial action plans.
• Develop and implements loss prevention educational programs and materials.
• Draft or review documents to reduce institutional exposure to liability.
• Perform other duties as required or assigned.

Qualifications

• Bachelor’s degree in nursing, health-related field or risk management required.
• Master’s degree in nursing, healthcare administration, or related field preferred.
• Juris doctorate may be considered.
• Five (5) years of progressive risk management experience required.
• Experience in applying modern improvement methodology to lead changes required.
• Experience in the concepts and applications of continuous improvement including ability to manipulate date, trend and analyze data required.
• Seven (7) years previous risk management experience required in insurance claims, risk management, customer relations, legal experience, or as a health care provider, or the equivalent combination of education and experience required.
• Registered Nurse with five (5) years’ experience preferred.
• License(s)/Certification(s): Certified in one of the following required:Certified Professional in Healthcare Risk Management Associate in Risk Management Certified Professional in Patient Safety Current Nursing license in Iowa, Illinois or Wisconsin preferred.