About the Opportunity
Our client is an independent non-profit hospital and healthcare system offering a range of high quality health and wellness services. They are seeking a Risk Management RN to assist the Department Manager in all phases of Risk Management including litigation and claims evaluation, medical record review, preparation of summary reports and participation in Root Cause Analysis Teams related to actual or potential sentinel events. The successful candidate will also participate in Quality Improvement Committees.
The annual base salary range is $95,000 to $115,000. Actual compensation offered to the successful candidate may vary from posted hiring range based upon geographic location, work experience, education, and/or skill level, among other things. Details about eligibility for bonus compensation (if applicable) will be finalized at the time of offer.
Job Responsibilities
- Establish and maintain positive relationships with patients, visitors, physicians and other employees
- Contribute to and participate in the Performance Improvement and Quality Improvement activities of the assigned department
- Develop and monitor reports of occurrence data and harm events. Produce reports as requested on various department activities.
- Respond to inquiries or reports regarding potential or actual occurrences that implicate medical, legal, ethical or loss control issues
- Analyze and evaluate occurrence reports generated by employees or physicians departments and individuals responsible for Medical, Nursing and Utilization review in an effort to determine the significance and reportability of events
- Assist departments in determining appropriate corrective actions involving risk and medical error reduction
- Undertake investigation and follow up of occurrences involving risk management, quality of care issues or professional or general liability exposure
- Review and evaluate requests for medical information and/or records to determine appropriate authority of request and to screen potential requests for litigation implications
- Assist in the review and revision of department and company Policies as necessary.
- Participate in committees as needed at the direction of the Manager, Risk Management or Manager, Regulatory Affairs
- Assist in the investigation and preparation of case summaries for presentation at Clinical Review and/or Root Cause Analysis meetings
- Facilitate or participate in Root Cause Analysis team meetings
- Interface with medical records department as necessary to ensure efficient processing of inquiries from regulatory agencies and legal representatives of patients.
- Preview potential compensable events at monthly claims committee. Follow up on corrective action from meetings and assist in claim reporting and verification activities.
- Provide written critical analysis of cases and recommend policy or procedural changes as warranted.
- Follow up for risk reduction strategies and corrective action in response to sentinel events or quality of care issues
- Develop and maintain programs for tracking and trending significant and/or reportable occurrences and professional practice concerns
- Assist the Manager, Regulatory Affairs, as needed with reporting to the Department of Public Health pursuant to legislative and regulatory guidelines
- Provide assistance to other departments under the supervision of the Manager, Risk Management, with preparation for regulatory surveys and site visits
- Coordinate or participate in meetings with regulatory agencies
- Assist the Manager as needed with reporting to and interfacing with regulatory agencies on compliance issues
- Provide in-service training at the new employee/physician orientation sessions and other venues regarding risk management issues and department functions
- Participate in and/or attend educational seminars and conferences at the request of the Manager
- Assist with staff educational programs involving patient safety, medical injury prevention, documentation, informed consent policy and procedures, occurrence reporting, Joint Commission reporting, reporting involving other regulatory agencies, organ donor policies and procedures, End of Life and Do Not Resuscitate policies and procedures, Health Care Proxy policies and procedures, and other programs as requested or as determined by the Department of Risk Management.
Job Requirements
- Registered Nurse is required
- Bachelor’s Degree in nursing from an accredited college is required with a Master’s Degree preferred
- A minimum of 3 – 5 years clinical nursing experience is required
- 1 – 3 years of relevant risk or insurance experience is preferred
- Excellent written, oral and communication skills are essential
- Demonstrated organization skills are essential
- Experience in the utilization of quality improvement methods related to data management and analysis is required
- Experience developing and conducting educational programs
- High level of competency with computer software such MS Word or equivalent is required
