Risk Claims Manager

Job Description

Job Description

 

 

Job Description

Title Risk Claims Manager

Job Description

The Risk Manager oversees Risk Management activities at Osborn Family Health Center ("Osborn"). Risk management activities shall be part of the daily responsibilities of the Risk Manager.

The Risk Manager is responsible for the implementation and coordination of the Risk Management Program. The Risk Manager is empowered by the Board with the authority and responsibility necessary to perform the functions and activities of the Risk Management Program. The Risk Manager is responsible for developing and implementing appropriate measures to minimize the risk of injuries to patients, visitors, and staff, and to minimize loss or damage to property or the reputation of Osborn in collaboration with other staff.

The Risk Manager also serves as Osborn's Claims Manager. The Claims Manager is the claims point of contact. Claims management activities shall be part of the daily responsibilities of the Claims Manager.

 

Duties and Responsibilities

Risk Management Duties

• Develops, initiates, maintains the Risk Management Program and Risk Management Plan of the Health Center. Oversees Risk Management investigation, training, and corrective action if necessary.

 

• Review all incident reports; investigate and analyze the frequency, causes, and trends of general categories and specific types of adverse incidents.

 

• Coordinate analysis of serious incidents or undesirable patterns or trends.

 

• Assist with development, implementation, and ongoing monitoring of risk reduction strategies.

 

• Complete risk management assessments at least quarterly and share such assessments with the QA/QI/ RM Committee and Board.

 

• Assist departments in identifying and correcting unsafe conditions and high risk or problem prone processes.

 

• Incorporate risk management findings with the RM program and initiatives.

 

• Implement an annual Risk Management Training Plan that includes analyzing data to identify training that must be completed by all staff and additional risk management training for select staff involved in certain professions/fields, and tracking and monitoring staff compliance with training requirements.

 

• Annually report to the Board on risk management activities and progress in meeting goals.

 

• Other responsibilities as requested by management.

Claims Management Duties

• Oversee claims and insurance management

 

• If Osborn is deemed an employee for purposes of coverage under the Federal Tort Claims Act ("FTCA"), duties include:

 

(1) assisting the Department of Health and Human Services Office of General Counsel in defending administrative torts filed against Osborn or pursuant to the FTCA

(2) promptly sending any service of process or summons, to both to the Department of Health and Human Services, Office of the General Counsel, General Law Division in accordance with the FTCA Health Center Policy Manual, and to other outside representatives

• Assist to have improperly filed state claims dismissed against Osborn or any of its employees in a timely and responsible manner.
• Ensure that litigation holds are issued immediately upon receipt of any notice of litigation, including but not limited to a state claim or administrative tort claim, to prevent the loss or alteration of any information relevant to the claim, including but not limited to records concerning medical treatment, billing, communications between involved parties, personnel records, and policies and procedures in effect at the time of the incident.
• Work cooperatively with other representatives on Osborn's behalf with respect to claims management.

 

Education/Experience: Associate's degree in health care management, nursing or administration in related field required. Bachelors' degree preferred. 

At least three to five years of related experience preferred.

Reports to: Clinical Nurse Director/Chief Medical Officer

 

 

 

 

The following statements reflect the general duties, responsibilities and competencies considered necessary to perform the principal functions of the job and shall not be considered as a detailed description of all work requirements that may be inherent in the position.

Osborn Family Health Center is a Federally Qualified Health Center (FQHC), located in Camden, N.J, Equal Opportunity Employer.