Risk Manager

Posted June 4, 2024

Job Description:

Centered in beautiful Southern California, Adventist Health Simi Valley has been one of the area’s leading healthcare providers since 1965. We are comprised of a 144-bed hospital, home care services and a vast scope of award-winning services located throughout Ventura County. Simi Valley is a suburban area nestled between an urban oasis and the stunning shores of the Pacific Ocean. Bordering Los Angeles allows hiking in the morning and attending film premieres in the evening.

Job Summary:

Manages and oversees the Risk Management Program for the organization. Develops and implements appropriate measures to identify/minimize the risk of injury to patients, visitors and staff, and to minimize loss/damage to property. Responds to all patients/visitors complaints/concerns that cannot be dealt with at the unit level and takes appropriate corrective action. Supervises/directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment.

Job Requirements:

Education and Work Experience:
Bachelor’s degree in a healthcare-related field or equivalent combination of education/related experience: Required
Master’s degree: Preferred
Five years’ technical experience: Preferred
One year’s leadership experience: Preferred

Essential Functions:

Coordinates investigation/reporting of incidents in accordance with the Safe Medical Devices Act and organizational requirements. Maintains hospital-wide occurrence reporting system. Identifies and communicates trends in patient complaints, patient service programs and risk management issues to executive management. Directs and ensures efficient/effective occurrence review and claim file management. Functions as an internal/external liaison in managing potential/actual claims against the organization. Ensures departmental support/participation in the Patient Safety process by evaluating individual files/trend data for compliance/regulatory requirement issues. Provides risk management information on medical/allied health staff to medical staff services for use in the credentialing process.
Risk Management / Liability Claims Liaison: Acts as Site Administrator for RADAR Claims Module (Potentially Compensable Event) and maintains legal case files. Investigates and reports potentially compensable events (PCEs) and asserted claims (demands for compensation, services or litigation) to the Trust pursuant to the corporate policy for reporting to the Trust. Provides investigation findings/information to claims staff including identity of location/site/clinic involved, identity (full name, job title) of involved parties, witnesses (how they are/were involved) etc., narrative description of the events, issues identified and recommendations for additional investigation.
Investigates and responds (in writing) to requests from patients/visitors for compensation or payment for services, e.g., physical therapy, home health, specialist consultation, etc. Serves as primary contact for defense counsel and corporate claims staff. Facilitates/verifies discovery and requests for documents, information, interviews and depositions. Obtains concurrence for settlement, trial, etc. Works with legal counsel to coordinate investigations, process and defend claims against the facility. Obtains/maintains records and documents and provides them to defense attorneys for preparation of testimony in pending litigation.
Safeguards materials obtained or developed for root cause analysis to ensure documents/proceedings are protected from discovery. Initiates and monitors efforts to preserve evidence, i.e., surveillance video, equipment memory, etc., and/or litigation holds. Attends trial as site representative, coordinates litigation activities involving site interviews, depositions, witness preparation, etc. Approves payment for replacement of lost property after claim evaluation. Negotiates settlement of small claims within administrative authority and advises collection department of appropriate action for unpaid accounts involved in litigation.
Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.

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