Brewer , Maine, The Director of Risk Management will be responsible for providing leadership and executing strategy across Northern Light Health and its affiliates by leading and supporting Risk Management Professionals (RMPs) toward consistent best practices, including: pro-active surveillance, risk assessments, reporting and investigation of actual and potential events, as well as education of employees and medical staff on risk management related topics. S/he will be responsible for the design, utilization and oversight of an identified risk information management system (RIMS) creating and maintaining standards and processes for the electronic documentation and management of events from initial intake through investigation and to closure. S/he will seize opportunities to implement innovative ideas; take initiative to deliver results beyond the status quo; and adapt to changing circumstances by maintaining flexibility.
The Director will support the VP of Risk Management & Patient Safety in prioritizing the ongoing development, implementation, evaluation and coordination of the Northern Light Health Risk Management program with an objective of controlling and minimizing professional and general liability (PL/GL) claims, as well as participating in loss prevention, safety and quality improvement activities. S/he will employ the five principles of a High Reliability Organization (HRO) in their leadership and support a just and safe culture.
Job Functions and Duties:
1) Direct the Northern Light Health Risk Management Program.
Assist with recruitment, training, development and evaluation of RMPs.
Effectively collaborate with member organization RMPs and third-party administrators (TPA) to complete risk assessments and develop plans for controlling risks identified.
Develop and monitor system trends and event triggers of actual or potential adverse events to prompt an investigation, analysis, development of risk mitigation strategies while identifying potential liability or legal action.
Develop and conduct presentations for various audiences to demonstrate event trends and risk management program plan, progress, and accomplishments in conjunction with VP of Risk Management.
Oversee and assist with efforts to coordinate risk related system policies to ensure consistency and standardization while maintaining each member organizations autonomy when applicable.
Contribute to developing systemwide tool and processes to support and educate on event management and investigation for all audiences, including: RMPs, employee safety/human resources, clinical engineering, facilities, inpatient and outpatient managers, frontline staff, and more.
Develop and support harm & severity methodologies to allow for risk analysis, prioritization, and risk reduction strategies systemwide.
Encourage and supports HRO principles:
a. Preoccupation with Failure
b. Reluctance to Simplify
c. Sensitivity to Operations
d. Commitment to Resiliency
e. Deference to Expertise
? Support all efforts related to the Enterprise Risk Management program at Northern Light Health, as required.
2) Direct the internal and external processes related to PL/GL claims management and represent NLH's values and priorities.
Coordinate or conduct investigation, evaluation, management and resolution medical professional liability claims against physicians and other healthcare providers with which the company may contract with or employ.
Interact effectively and appropriately with various parties involved in an adverse medical event.
Facilitate the investigation of each reported incident/loss claim to obtain data necessary to create an event in a claims database and effectively manage the claim.
Direct the claims review and reserve process to ensure adequate communication of new cases and adverse developments and timely reserving practices.
Independently assess anticipated claim expense and indemnity payments to recommend valuation to VP of Risk Management & Patient Safety and/or General Counsel.
Effectively collaborate with outside counsel on status of cases and strategic recommendations regarding case management.
Participate in mediation, panel hearings and trials of assigned claims.
Proactively resolve claims within established guidelines and/or authority levels.
Review outside counsel bills to ensure appropriateness of fees and expenses.
Assist VP of Risk Management & Patient Safety on claims presentations to claims review committee and senior management.
Assist VP of Risk Management & Patient Safety in responding to inquiries from insurance carriers and outside auditors.
Assist VP of Risk Management & Patient Safety in managing the company-wide loss data.
3) Support RMPs at each Member Organization in all matters related to Risk Assessment, Identification, Analysis, Response (Treatment), and Evaluation (I.A.T.E.).
Oversee and support RMPs with risk surveillance, identification, and timely communication of serious and reportable events to executive management, quality, compliance, legal, department chiefs, and public relations to ensure regulatory compliance with State, Federal, and accrediting agencies.
Develop tools & education; standardize processes; provide support and training, and oversee performance and compliance to support Risk Management Professionals across the system in the following risk processes:
Risk Surveillance Methods
RIMS Event Workflow
Event Investigation
Risk Mitigation Strategies.
Interact effectively and appropriately support and guide various parties involved in adverse medical event investigations.
In conjunction with System Risk Manager and business owner of incident reporting system, collaborate with key stakeholders on the development and expansion of the system to support the strategic goals of Northern Light Health.
Review event workflow effectiveness with RMPs and collaborate to remove barriers to ensure all events are given the attention required in a timely manner to support Northern Light Health event management principles.
Education and Experience:
Bachelor's Degree; Master's degree preferred.
Minimum 10 years of experience as a licensed clinical professional and 5 years in healthcare risk management; or 10 years in healthcare risk management.
Certification in Healthcare Risk Management required.
Training in Lean, Six Sigma or other performance improvement programs preferred.
Computer experience using Microsoft Windows and Microsoft Office software products required, with strong skills with Excel and Visio.
Experience and understanding the integration of software systems, technical design/build processes, and reporting features associated with electronic health records, incident reporting systems, and/or other databases.
Experience facilitating, performing, and/or participating numerous event investigations and root cause analyses.
Experience creating and managing projects or work plans including meeting facilitation, tracking progress, and meeting deliverables/milestones on time.
Knowledge, Skills, and Abilities:
Advanced computer skills with excellent typing skill and efficient use of Outlook, Excel; Word a must and preferred experience with Visio and Microsoft Project.
Exceptional communication skills, including oral, written, and presentation skills with the ability to translate complex concepts into layman's terms to meet the audience's needs.
Exceptional analytical, organizational, decision making and problem-solving skills.
Strong documentation skills with high attention to detail.
Exceptional time management, organization and prioritization skills including the ability to create and manage project plans.
Able to analyze and assess processes, including current/future state and gap analysis.
Able to analyze data to identify trends and validate the data integrity such as ensuring the data accurately represents its intended goal.
Able to build positive relationships and partnerships and work collaboratively with people and teams throughout the company and with external parties.
Professional and tactful negotiation and persuasion skills to influence other's opinions and decisions without express authority.
Working Environment:
Busy office environment, seated at a desk, with option to stand, for extended periods of time.
Work involves daily use of a computer and telephone.
Some travel is expected to member organizations and for professional development.
Interaction with colleagues via video and telephone conference calls required.
Equal Opportunity Employment We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.
Physical Requirements:
Sedentary work requiring good manual dexterity for keyboarding.
Work requires repetitive motions of wrists, hands and fingers.
Must have correctable vision to work with a computer monitor, excellent hearing and listening skills to receive and give detailed information through oral communication.
Extended periods of sitting, with option to stand, at computer.
Some travel to Member Organizations.
Ability to communicate in person and over the telephone; to effectively speak publicly; to work independently and in team environments; to work under pressure with precision and accuracy; and to handle multiple projects simultaneously.
*Note: the list of duties above reflect the majority of the duties of this job and does not, nor is it intended to, reflect all duties that may be required for an incumbent in this job to perform.