RN, Sr. Consultant Risk Management

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more – in our careers and in our communities. Job Description Summary: Because the organization self-insures professional liability claims, the Senior Consultant, Risk Management is responsible for risk assessment, analysis, prevention, and education to reduce the frequency and severity of losses and protect corporate assets. Primary duties include monitoring and documenting patient outcomes with the potential to result in professional liability claims; analyzing clinical care and preparing reports on the effectiveness and appropriateness of care; investigating, evaluating, and resolving allegations of professional negligence in collaboration with complainants and claimants, including negotiating financial settlements when authorized; assisting the General Counsel and external trial counsel with litigation matters. The Senior Risk Consultant may administer self-insured general liability claims as a third-party administrator/claims adjuster, including settlement negotiations when authorized and support the Property/Casualty Risk Consultant in the investigation and management of casualty lines (e.g., property, fleet, pollution, and environmental exposures). The Senior Risk Consultant may develop and deliver standardized and customized risk management in-services and presentations for diverse audiences. This job profile summarizes key responsibilities and is not intended to be exhaustive; duties may change at any time. As a High Reliability Organization (HRO), responsibilities require focus on safety, quality, and efficiency in performing job duties. Responsibilities And Duties: 1. Patient Complaint/Claims management 35% Meets with patients, families, visitors, as well as clinical, ancillary, & administrative staff, and physicians, to assist/consult with, or take a lead role as indicated, in confronting and managing serious patient and visitor complaints & grievances, typically alleging substandard, or inappropriate professional care and treatment ; investigates the validity of the complaint/claim, analyzes medical records, interviews associates as indicated, negotiates and manages resolution of complaints and claims while balancing corporate interests and service recovery ; consults with the Risk Manager for case management, and settlement authority in negotiating and settling patient claims. 2. Unusual occurrences management-20 % 1 Analyzes all UORs & miscellaneous hospital reports on-line UORs, Attorney Requests for Medical Records, Quality variance reports, et c and identifies those having professional liability claim potential; initiates follow-up and/or investigative activities where indicated; reports significant findings to the Risk Manager, Legal, and Safety & Quality leadership; monitors for and reports significant UOR trends to . 2 Monitors for and generates dedicated reports of Safety incidents; notifies designated management/ leadership personnel of significant findings; actively participates in follow-up and investigation of incidents, participates in all Safety Event meetings/Root Cause Analyses; participates in Disclosure discussions with patients & families as requested by Hospital Safety & Quality leadership; completes clinical chart reviews and presents case summary at monthly Reserves meeting for significant/serious incidents. 3. Litigation management- 20% Functions as the hospital/division liaison in assisting the General Counsel, in-house counsel, and external trial counsel with litigation-related activities; carries a litigation case load as assigned by the Legal department; completes clinical chart reviews and presents to the General Counsel for Reserving purposes; collaborates with and/or manages all requests for assistance from in-house counsel and external trial counsel in assisting with completion of interrogatories and production of documents requests, and other legal discovery activities as necessary; coordinates meetings between associates and trial counsel, schedules depositions of associates; attends/participates in litigation-related meetings & trial activities as delegated. 4. Liability & Casualty Insurance claims manager- 10% Reviews, investigates, & analyzes general liability incidents & claims to determine the nature and extent of any hospital exposure/liability; in collaboration with the Risk Manager, Systems Director, and/or the General Counsel, for claims within the self-insured retention, is given authority to negotiate & settle claims; functions as the on-site insurance contact to capture data & submit claim reports for multiple other lines of casualty insurance coverage, i. e Property damage, fleet/auto accidents, pollution/contamination incidents; Assists the Risk Manager and Systems Director with data collection for the Corporations annual insurance renewal process; continually monitors the environment to identify issues having insurance coverage/ adverse exposure implications. 5. Meeting representation-10 % Represents the Risk Management department at a wide variety of committee meetings including but not limited to, Safety, Security, Quality, Patient Safety, & Ethics and Compliance, and as a member of specialized task forces for the purpose of contributing perspectives/recommendations on Risk Exposure, Risk Reduction, and Risk Prevention. 6. Education & Training 5 % Ensures the delivery of both proactive and reactive Risk Management education and training to a wide variety of hospital & ambulatory audiences and venues, inclusive of clinical, medical, ancillary/support services, &administrative personnel; Takes an active role in developing customized Risk Management in-services/presentation materials; may be engaged as a public speaker at professional organization seminars, and at academic centers, and /or to provide shadowing experiences for students. As a High Reliability Organization (HRO), responsibilities require focus on safety, quality and efficiency in performing job duties. The job profile provides an overview of responsibilities and duties and is not intended to be an exhaustive list and is subject to change at any time Minimum Qualifications: Bachelor's Degree: Nursing (Required)RN - Registered Nurse - Ohio Board of Nursing Additional Job Description: Comprehensive knowledge of healthcare operations, with demonstrated expertise in complaint and grievance management, conflict resolution, negotiation, and complex problem-solving. Proficient in Microsoft Office (including PowerPoint) and database management. Highly detail-oriented, service-driven, and effective in managing multiple priorities. Highly detail-oriented with strong time management skills. The Senior Risk Consultant is relationship-focused, with effective public-speaking and presentation skills for large audiences and senior leadership. Work Shift: Day Scheduled Weekly Hours : 40 Department Risk Management Join us! ... if your passion is to work in a caring environment ... if you believe that learning is a life-long process ... if you strive for excellence and want to be among the best in the healthcare industry Equal Employment Opportunity OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment