Director of Claims & Senior Counsel

Position Title Director of Claims & Senior Counsel Days - Full Time Olathe Hospital Position Summary / Career Interest The Director of Claims & Senior Counsel for The University of Kansas Health System (TUKHS) has broad responsibility for identification, prevention, and mitigation of actual and potential risk to TUKHS, including The University of Kansas Hospital Authority (UKHA) facilities and providers across all campuses and locations, managing professional and general liability claims for the Kansas City, Southwest Kansas City, Great Bend and Liberty markets. Priority claims responsibility will be provided for the community hospital markets. Primary responsibilities also include supporting legal department functions with TUKHS's Office of the General Counsel, including assisting with development/coordination of clinical risk management programs; providing guidance on potential sources of loss/risk and mitigation strategies; counseling and advising on potential liability and regulatory exposures; and collaborating with TUKHS, The University of Kansas Physicians (UKP) and Kansas University Medical Center (KUMC) compliance, risk, and regulatory departments, as well as governmental and regulatory agencies. The Director of Claims & Senior Counsel partners with TUKHS Clinical Risk Management in monitoring and analyzing patient safety events and providing education to practitioners on claims and risk mitigation strategies, acting as a consultant to leadership on promoting a culture of safety. Duties include maintaining responsibility for protection of the health system, its employed practitioners, and affiliates in management of insurance claims, including investigation, recommendations for action/remedy. This position collaborates closely with Directors of Insurance, Claims, Clinical Risk Management, Patient Safety/Quality, Compliance, and Patient Relations. Responsibilities and Essential Job Functions Report, respond to, review, and resolve claims, in accordance with TUKHS's Communication and Resolution Program. Participate as member of facility or enterprise crisis management teams pursuant to applicable policies. Collaborate as requested with TUKHS hospital medical staff offices and medical staff leadership to facilitate investigations, assuring all relevant privileges and protections are triggered/preserved. Present claims to Claims Committees for TUKHS's Risk Retention Group and Captive. Participate with Senior Leadership and legal counsel in formulating defense strategies. Maintain strong relationships with various stakeholders, including, but not limited to, incumbent broker(s), captive manager, third party claim administrators, the Health Care Stabilization Fund (HCSF), excess carriers and reinsurers, and defense law firms. Counsel practitioners on process and procedures involved with root cause analysis meetings and investigations, providing support as needed. Assist practitioners with answering questions on licensure and credentialing applications which includes obtaining necessary documents to accompany the application. Assist with reviewing patient warning letters, discharge outpatient care, and termination letters. Collaborate with Human Resources, when needed, to ensure that HR-related issues and findings are effectively documented, and necessary corrective actions are taken. Notify the HCSF of potentially compensable events, claims, or lawsuits. As requested by the HCSF, assist with preparation for trial, including sending litigation holds, and assisting with discovery. Request medical records and copies of bills for patient complaints, demands, and claims. Provide independent, unbiased, and discrete assistance to TUKHS practitioners regarding potential claims at the pre-claim stage; and investigate cases identified as potential risk issues, with a goal of mitigating professional liability exposure and harm to professional reputation. Attend mediations and trials on behalf of TUKHS providers Review and track claims identifying potential risk issues. Review and investigate patient/family complaints, patient demand letters, and incident reports; make recommendations to HCSF if requested regarding disposition of complaints and demands. Assist providers with response to patient complaints in coordination with the Clinical Risk Management and Patient Relations departments. Assist, when called upon, to assure compliance with various codes, laws, rules, and regulations concerning patient care (including those mandated by state and federal agencies), incident reporting and investigation activities in support of Legal, Compliance, and Clinical Risk and Regulatory departments. Request bill holds, make recommendations for waiver of bills, and attend bill-hold meetings. When necessary or prudent, request counsel for practitioners and, as requested by the HCSF, serve as the liaison to attorneys for requests to interview practitioners, obtain depositions for subsequent treating prac #J-18808-Ljbffr Kansas Health System