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JOB DESCRIPTION The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization. This salary range may be inclusive of several career levels at Valley MedicalCenter and will be narrowed during the interview process based on several factors, including (but not limited to) the candidate's experience, qualifications, location, and internal equity. TITLE: Director Risk Management JOB OVERVIEW: The Director, Risk Management is responsible for assessing, managing and mitigating potential and actual financial impact on Valley Medical Center. DEPARTMENT: Risk Management WORK HOURS: As required to fulfill responsibilities REPORTS TO: Valley Medical Center, GeneralCounsel PREREQUISITES:

Bachelor's degree required, preferably in Public Health, Healthcare Administration, Nursing, or related field. Master's degree or Juris Doctorate preferred.

Minimum 7 years' risk management experience required, including managing professional liability events and risk financing in a health care setting and/or professional liability claims for multiple lines of insurance.

Clinical experience preferred.

Experience working with the public to resolve disputes and familiarity with public records in a public hospital and state hospital, preferred.

Associate in Risk Management (ARM) or certificate program in Healthcare Risk Management (CPHRM), preferred.

Minimum 5 years managerial or supervisory experience required.

QUALIFICATIONS:

Demonstrated proficiency in mentoring colleagues.

Experience-based knowledge of medical professional liability exposures and laws, investigation and negotiation techniques.

Thorough knowledge of the principles and practices of Risk Management.

Effective and professional oral and written communication skills.

Proven ability to organize and analyze data and to problem-solve using continuous quality improvement techniques to improve processes and outcomes.

Demonstrated familiarity and ability to use Word & Excel and similar software products independently.

Experience developing and using databases to report information

UNIQUE PHYSICAL/MENTAL DEMANDS, ENVIRONMENT, AND WORKING CONDITIONS:

The ability to workat a computer for extended periods of time.Travels to various departments, including off-site locations, as needed for site assessments, educational programs, and consultations.Available for emergency consultations as needed during off-hours, via phone.Safety position requires work to be performed both inside and outside, in all types of weather as required. Potential exposure to refrigerator burns, infections, chemicals, gases, bruises, cuts, electrical shocks, dust, dirt and skin and lung irritations. When working in a hazardous location the employee is required to utilize proper safety clothing, gear and equipment. This position requires occasional irregular hours. PERFORMANCE RESPONSIBILITIES

A. Generic Job Functions: See Generic for Administrative Partner

B. Essential Responsibilities and Competencies: Claims Management Responsiblities:

Leads the operational, planning and personnel activities of the claims program and liability program. May supervise work of third party administrators and adjusters. Works with insurance brokers and other advisors to manage claims program effectively and efficiently.

Direct oversight of complex liability claims, including: Investigating claims and lawsuits. Determining appropriate coverage source for entities and individuals named in claims and lawsuits. Collaborating with co-defendants within legal privileges and constraints of insurance program. Evaluating liability and damages. Consulting with attorneys and others. Selecting defense counsel. Negotiating settlements within delegated authority; obtaining authority for amounts in excess of delegation. Monitoring a case through trial. Communicating lessons learned from claims and lawsuits. Entering claim information into claims data base consistent with data integrity standards.

Reports claims to excess insurers/reinsurers as needed on claims and fulfills their communication and timeliness requirements. Reports to excess insurers on "circumstances" identified by the clinical risk management program.

Prepares reports to the State Disciplinary Boards, the National Practitioner Data Bank and other regulatory bodies as required for medical malpractice claims. Recommends allocation of financial responsibility among named defendants.

Develops and executes communication strategies with internal clients, insurers, adjusters, and service providers so that information needs are met and claims outcomes are optimized. Maintains effective, positive communication with General Counsel, outside counsel, insurers, insurance brokers, and other strategic partners.

Analyzes losses and recommends strategies to reduce losses. Consults with General Counsel and others on optimal risk transfer strategies based on loss experience.

Develops and implements best practices for the claims program. Stays abreast of national and local trends and analyze pertinent state and national legislation.

Develops and implement procedures necessary for the data and document collection, communication, and retention necessary for Valley's captive insurance company, underwriters, actuaries, auditors, and regulators. Ensure that data and work processes are compliant with state and federal privacy laws. Direct the work of coverage counsel when required.

Clinical Risk Management Duties:

Plans, implements, and directs the clinical risk management program and the patient relations activities of Valley Medical Center in accordance with the hospital's standards and procedures to prevent and reduce liability exposures related to patient care delivery. This includes: Directs and provides services to identify and resolve clinical risk management issues associated with adverse patient events in active collaboration with quality improvement, medical staff office, and patient safety programs in event reviews as part of the entity and/or UW Medicine's quality improvement program procedures. Manages charge waivers in accordance with compliance policy and applicable law. This includes: Development of systems for the regular review of adverse events (incidents) to identify those requiring further investigation, including reports as circumstances to underwriters. Supervision and/or implementation of investigation plans in collaboration with clinical leaders, quality improvement and patient safety staff members. Maintenance of investigation records in accordance with department and VMC procedures for record retention. Directs the activities of Valley Medical Center's patient relations program and program staff to restore positive patient relations by identifying and resolving service quality or clinical risk management concerns. Develop, implement and maintain effective systems for the regular management of patient complaints and grievances, including the documentation standards and management of entity's committee oversight. Supervise grievances in accordance with entity policies and procedures, state and federal regulations, and accreditation standards. Provides leadership in the development and/or implementation of risk management policies and procedures. Provides consultation support to assigned entities regarding medical legal topics such as disclosure of unanticipated outcomes of care, informed consent, termination of patient care, patient rights and end-of-life decisions. Serve on assigned entity-level committees such as quality oversight committees. Plans and delivers regular clinical risk management education programs to orient the staff of assigned entities to clinical risk management topics. Develops targeted educational interventions in response to emerging trends or changing law or standards.

Leaderhsip:

Supervision of all program staff.

Responsible for programmatic accreditation/regulatory compliance for department records associated with claims, clinical events and grievances, including but not limited to DOH Adverse Event Reporting, TJC Sentinel Event review criteria, FDA Safe Medical Device report criteria, CMS Conditions of Participation, HIPAA and the healthcare information act, account waivers accomplished in compliance with the False Claims Act, and other regulations and standards as applicable. Assures that records created by assigned staff are kept and maintained in accordance with department procedures and the relevant record retention schedules.

Ensures the accurate capture of investigation activity in information systems in accordance with VMC risk financing needs, department procedures and the relevant record retention schedules.

Manages the use of reports from information systems to drive medical malpractice prevention and quality improvement efforts and to provide appropriate education to clinicians to reduce the risk of patient harm.

Manages and chairs the Risk Management Committee meeting, including preparation oversight with key team members, including Executive team/Medical Staff Leadership and quality improvement and patient safety partners. The Committee also serves as the Grievance Committee required by CMS regulations. This includes agenda development and ensuring that timely and accurate meeting minutes are produced and retained and review of Risk Management charter.

May represent the department at meetings or task forces.

Performs other related job duties as required.

Revised: 9/25

Grade: NC-16

FLSA: E

CC: 8710

Job Qualifications:

PREREQUISITES:

Bachelor's degree required, preferably in Public Health, Healthcare Administration, Nursing, or related field. Master's degree or Juris Doctorate preferred.

Minimum 7 years' risk management experience required, including managing professional liability events and risk financing in a health care setting and/or professional liability claims for multiple lines of insurance.

Clinical experience preferred.

Experience working with the public to resolve disputes and familiarity with public records in a public hospital and state hospital, preferred.

Associate in Risk Management (ARM) or certificate program in Healthcare Risk Management (CPHRM), preferred.

Minimum 5 years managerial or supervisory experience required.

QUALIFICATIONS:

Demonstrated proficiency in mentoring colleagues.

Experience-based knowledge of medical professional liability exposures and laws, investigation and negotiation techniques.

Thorough knowledge of the principles and practices of Risk Management.

Effective and professional oral and written communication skills.

Proven ability to organize and analyze data and to problem-solve using continuous quality improvement techniques to improve processes and outcomes.

Demonstrated familiarity and ability to use Word & Excel and similar software products independently.

Experience developing and using databases to report information