General Definition and Scope of Job:
Under the direction of the Chief Medical Officer (or designee), is responsible for the Risk Management Program and related projects. Reviews and recommends to the CMO administrative policies and procedures, as indicated. Facilitates staff education regarding commitment to Manet’s commitment to Risk Management Compliance.
1. Serves as internal consultant to leaders, department heads, and staff on matters of risk management.
2. Works in conjunction with the Quality and PI Manager to ensure highest quality of care, and any risk issues are addressed.
3. Reports to the CMO, but also maintains direct communication with the Senior Director Human Resources in matters of non-clinical risk management.
4. Maintains current and accurate knowledge of pertinent regulations, laws and standards.
5. Acts as Claims Manager for all claims related activities and serves as the claims point of contact.
6. Gathers, analyzes information and reports on incidents and complaints on a monthly, semi-annual and annual basis.
7. Prepares quarterly, semi-annual and annual reports for leadership, governance and regulators.
8. Identifies potential risk management areas and works with CMO to resolve issues. Develops reports based upon findings from occurrence monitoring and assists with staff education related to same.
9. Directs safety occurrence reporting and serious complaint management systems including investigations, in-depth, root cause and failure mode analysis, proactive risk assessments, action and reporting. In collaboration with the Directors of Clinical Services and Operations, investigates, reports and coordinates related corrective action plans for adverse events.
10. Performance Improvement Committee /Risk Management–. Ensures that patient risk management protocols and regulations are monitored continuously and that follow-up actions are taken, as necessary. Collaborates with leadership to identify and set priorities to annual risk management goals; organizes trains all staff on Risk Management.
1. Other duties as needed.
Minimum Skills, Experience and Educational Requirements:
1. Five to 10 years’ experience successfully implementing quality and compliance programs in a complex health care environment, FQHC preferred.
2. Bachelor’s degree in nursing with current MA nursing license preferred, LPN required with current MA active license. Master’s preparation in nursing preferred. Clinical experience required.
3. Master’s preparation in relevant field preferred, (e.g. MHA, MPH, MPA, and/or MBA).
4. CPHQ certification preferred.
5. Working knowledge of a variety of rigorous process improvement and quality outcome measurement methodologies, such as Lean, Change Management, Value Stream Mapping, Rapid Cycle Testing, PDSA, FMEA, 330 Health Care and Business Plans, Healthy People 2010/2020, HEDIS, P4P.
6. Proven leadership, meeting facilitation, project management and time management skills.
7. Effective computer software skills including performance management-related applications and database management. Computer literacy and the ability to perform sophisticated statistical analysis.
Skills, Abilities, Competencies Required:
1. Critical thinking, decision making and problem solving: Able to anticipate and manage current issues, exhibit critical thinking and sound judgment, use reason, even when dealing with emotional topics, take action to resolve conflicts and problems. Able to review primary and secondary data, determine facts, identify trends and patterns, weigh options, offer solutions, make recommendations, and report data clearly, succulently, and objectively.
2. Flexibility: Able to remain open-minded and change opinions on the basis of data and/or new information; perform a wide variety of tasks and change focus quickly as demands change; manage transitions effectively from task to task; anticipate, plan for and adapt to varying patient / customer needs.
3. Leadership: Able to assume a role of authority as necessary; advocate new ideas, even when risk is involved; set an example for coworkers; delegate responsibility and empower associates to make decisions; provide constructive feedback to others. Must have excellent interpersonal, communication, written and presentation skills, and the ability to collaborate with leadership, providers, allied health and administrative staff and partner agency staff.
4. Planning, prioritizing and goal setting: Able to prepare for emerging patient / customer needs; manage multiple projects; determine project urgency in a meaningful and practical way; use goals to guide actions and create detailed work plans and action plans; organize and schedule self, people and tasks. Lead the transition of assigned project results to the operational process owners at the time of project closure, including developing a feasible plan to spread and sustain improvements.
5. Systematic problem solving: Able to apply systems thinking to generate solutions; focus on process rather than isolated events; obtain multiple assessments of a situation and be systematic in identifying and eliminating variation and trouble spots; use tools to define problems; evaluate alternative solutions. Develops outcome measurement and analytic strategies including identification of key metrics and data sources. Establish practical data collection, change management and communication plans. Expertise in working with quantitative operational, clinical and financial health care data is essential.
6. Compliance: Carries-out responsibilities in keeping with applicable laws, regulations, and industry standards; alert to potential for internal problems and reports concerns appropriately.
Critical Demands of the Job:
1. Manage multiple requests and prioritize appropriately.
2. Ability to function in a faced paced setting with a variety of patients and staff.
3. Attention to details and prompt follow up.
4. Includes walking and standing for long periods of time, sitting for short periods of time, hand dexterity, clear hearing and speaking ability. Must be able to lift a maximum of 1/3 of their body weight.
5. Excellent organizational and interpersonal skills.
6. Regular periods of high stress and long days related to planned or unannounced surveys and audits by external agencies.
7. Must be responsive to multiple deadlines.
1. Works in well-lighted environment with comfortable surroundings.
2. Stressful at times due to competing demands, including attention to multiple patients and staff.
3. Will comply with all applicable laws, and will cooperate with the Manet Community Health Center compliance program rules and regulations.
May be required to work evenings, holidays or weekends, if department requires.