Description: The Clinical Risk Manager –Acclaim is responsible for managing legal claims, including but not limited to identifying, evaluating, controlling, and minimizing exposure to loss or damage of physical assets, fidelity losses, and losses as a result of liability claims. The Risk Manager –Acclaim also ensures complete and sound claim settlements, legal reviews, and investigations when necessary.
- Plans, organizes, directs, and coordinates departmental risk assessment activities.
- Receives, reviews, and takes appropriate action on information regarding potential and actual compensatory events within specified time frames to include recording, collecting, documenting, and maintaining data.
- Collects, evaluates, and distributes data regarding incidents, claims, profiles, losses and other risk management reports.
- Coordinates the release of and provides requested information and documents related to potential and/or pending litigation; or in response to subpoenas, court orders, attorney requests and inquiries from external sources.
- Assists with and/or at times coordinates investigations, process and defend claims, and the evaluation of claims in collaboration with insurers, legal counsel and management.
- Researches liability exposures and recommends actions to minimize financial loss.
- Forecasts, trends, and develops losses and communicates potential liability to the Legal, Risk, Finance Departments and Administration to decrease financial obligations to the Physician Group.
- Provides guidance and assistance to staff dealing with liability incidents if they arise, ensuring complete and accurate information is recorded and secured in a timely manner.
- Researches, assembles, prepares and provides information and documents to legal counsel regarding Request for Production and Disclosure and Discovery Requests to support Acclaim's position in such matters.
- Reviews MIDAS reports daily in order to analyze potential legal and liability exposures in an accurate and proactive manner.
- Review all MIDAS reports of risk incidents on a timely basis and evaluates them to identify those that have actual or potential patient injury and follow up as necessary. (similar to #10 above)
- Researches and replies to all requests for malpractice and claims history verifications in collaboration with the District Attorney's Office and Acclaim Counsel.
- Provides notification to Lead Counsel's Office and Administration upon receipt of legal notices.
- Ensures the thorough review of medical discrepancies, analysis of data and follow up actions to improve patient care and patient safety.
- Educate staff and physicians on Risk Management strategies to mitigate loss and improve reporting in a just culture. Develop an education plan in collaboration with Education Department utilizing classroom training, internet and other techniques.
- Collaborate with Quality, Patient Safety and Patient Advocates to ensure that incidents are properly reported to regulatory agencies as required. Participate in committees dedicated to improving patient, employee and visitor safety and satisfaction. Assist with RCA process when appropriate and/or requested by Quality/Patient Safety.
- Performs other job related duties as assigned.