Risk Manager

Risk ManagerThe Risk Manager is responsible for the review and evaluation of events entered into the Atlantic Health reporting system, and to identify potential claims, lawsuits, and reportability under the Patient Safety Act. Refers events to Peer Review, Quality & Outcomes Management and other committees to address as appropriate. Organizes and moderates Root Cause Analysis and assists with the development of corrective action plans. Coordinates and facilitates regulatory investigations and responds as needed. Management of the resolution process related to complaint/grievances. Provides education to nursing, medical residency staff and all ancillary departments as needed. Manages translation services.Responsibilities include:Evaluates event for severity, frequency and probability of financial lossReports as appropriate to administration and committeesResponds to significant events; review facts; review medical record/documentation; preserve any evidence; conduct staff interviewsProvides recommendations for staff re: investigation/handling of events to appropriate management, administratorsRefers to Peer Review, Care Review, and Quality & Outcomes Management Committees to address as appropriateDevelop educational programs as appropriate or needed based on event findings and trendsReviews events and identifies potential claims/lawsuitsPrepares potential files, documenting factual investigation of eventCommunicates findings to the legal team as appropriate for case preparationReviews incidents and determines reportability as a Serious Preventable Event under the Patient Safety ActConducts initial team huddle and determines next steps along with Executive SponsorshipSubmits initial notification of SPE to DHSSOrganizes and moderates Root Cause Analysis meeting with health care providers involved to identify causal and contributing factors to the event, and assists with development of a corrective action planCoordinates case presentations to Preventable Events Review CommitteeAdvises site nursing staff, medical staff and administration on legal issues, billing, insurance, risk management, corporate compliance, EMTALA, HIPAA and other regulatory concerns following the review of regulations and standards.Addresses clinical queries by reviewing applicable policies and aligning responses with identified clinical needsServes as a resource for all inquiries, fostering ongoing open communication and engagementDelivers targeted education and in service training to nursing, medical, and residency staff, as requested or informed by needs identified through case review and event reporting trendsTopics include litigation process, documentation, event management, hospital policies, protocolsTriages events, escalate, investigates and refers as appropriate, close eventsAcknowledges clinical staff for Good CatchesProvide training to nursing staff, medical staff, and residency staff on use of programCoordinate and facilitate investigations (DHSS)(FDA) (CMS)Facilitate, prepare and submit material to agency and respond to deficienciesCoordinate voluntary and required reporting to the FDAProactive management of difficult patients and family members of complex care cases to mitigate complaintsLiaison between patient/family and nursing/physician teams to resolve concernsManage the response process as well as the electronic documentation of all clinical complaints/grievances in the databaseTrack and trend patterns of complaints/grievances and reports to leadershipEnsure compliance with DOH/CMS regulations regarding clinical patient complaints/grievancesManage and arrange language translation services for patients and families while ensuring compliance with regulationsProvide training to teams on language translation services as neededQualificationsRequired: • Bachelor's degree in Healthcare or related field preferred. • Minimum 7 years of Risk Management experience preferred • Minimum 3 years in Healthcare work experience required • Must pass a Level II Background Check Required Licenses, Certifications or Registrations:RN or other clinical professional licenseCPHRM within two years of hire