Location: Seattle, Washington
Type: Full Time
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UW Medicine Clinical Risk Management has an outstanding opportunity for a Compliance Analyst - Risk Manager to join their team.
The Risk Manager’s primary responsibility is to proactively manage adverse events, including the identification and management of those with professional liability exposures, provide consultation regarding clinical risk management matters, and develop and deliver risk management education programs as assigned, within UW Medicine and the Health Sciences Schools. The Risk Manager works in close collaboration with UW Medical Directors, Chief Nursing Officers, individual health professionals, directors, and managers and in close cooperation with Patient Relations, Patient Safety, Quality Improvement, Compliance, and/or billing staff for assigned UW entities. This position works to prevent and mitigate patient harm and the associated potential professional liability exposures and to ensure regulatory compliance with respect to the management of adverse patient events and patient grievances.
•Identify and manage and/or collaborate in the review of events involving patient harm for the purpose of improving patient safety and/or the quality of the care.
•Enhance the relationship between patients and those involved in patient care delivery via the successful management of patient grievances involving alleged harm.
•Provide proactive clinical risk assessments and advice as component of the relevant UW quality improvement program.
•Develop and deliver clinical risk management education programs for the purpose of medical malpractice prevention as part of UW Medicine coordinated quality assurance programs.
•Identify potential claims to reduce their adverse effects on the organization’s human, physical and financial assets and collaborate as necessary with others in the management of claims.
•Identify and address issues related to equity, diversity, and inclusion (EDI) related to the patient care environment and actively collaborate with patient safety and EDI colleagues in risk reduction activities.
This position provides both strategic direction and direct intervention in the most sensitive and highly confidential patient care situations encountered in the clinical enterprises. It interacts directly with physicians, nurses, quality improvement and patient safety officers when patients are harmed (death, serious surgical complications, etc.) in the course of care delivery. The Risk Manager interviews and coach’s faculty and staff, provides advice to health care executives about the management of serious patient harm events and regulatory compliance associated with them, and is the primary intermediary with patients and their families if a formal grievance is filed. The position requires highly developed analytical skills, familiarity with the clinical environment and the complexities of health law as well as excellent communication skills to gain the trust of physicians to effectively deal with these types of situations. The credibility of the individual is critical to the management of events as well as more proactive strategies provided through consultation and risk management education programs.
The Risk Manager provides direct support to the Health Sciences schools' clinical operations. Failure to appropriately manage the situation when patient harm occurs could result in significant adverse publicity and reputational harm to the University and to the relevant clinical entity. Failure to appropriately manage patient harm events, via mitigation or prevention, increases the University's exposure to medical malpractice litigation. This area of litigation is the most expensive from a risk financing perspective.
DUTIES AND RESPONSIBILITIES
•Create and maintain individual event review documentation and aggregate data about events (clinical incidents and accidents) involving patient harm or risks to patient safety to support on-going clinical risk management/mitigation and quality improvement initiatives.
•Review event (clinical incident/accident) reports on a daily and on-going basis to identify and manage or collaborate with others to manage events involving patient harm that may also be associated with professional liability exposure.
•Maintain accurate coding and analysis of events to support patient safety and quality improvement initiatives and compliance with regulations.
•Maintain information about individual events to support the management of claims by the UW Claims Managers.
•Collaborate with others to create and maintain reports for entity Boards of Directors, quality improvement, patient safety, and clinical risk management committees.
•Implement effective strategies to mitigate events associated with patient harm or to prevent patient harm by prospective consultation, including.
•Advise health professionals about documentation, informed consent and communication strategies.
•Recommend and manage administrative adjustments to patient accounts within the compliance policies of the UW clinical entity and/or Health Sciences Schools.
•Consult with the Attorney General’s Office about events as needed to facilitate the provision of legal advice to health professionals.
•Ensure compliance with federal and state laws related to clinical adverse events, including TJC, DOH, CMS, OFM, and FDA requirements.
•Identification of Sentinel/Adverse Events as defined by TJC and DOH, CMS-defined Hospital-Acquired Conditions, and Medicare Non-coverage Decisions in collaboration with the entity quality improvement staff, compliance, and billing staff and in accordance with the Policies & Procedures of the UW clinical entity or Health Sciences School.
•Identification and development of information related to equipment failures to ensure compliance with the reporting requirements of the Safe Medical Devices Act.
•Identify all events that meet requirements for reporting to other state or federal agencies to ensure that reporting occurs and is tracked.
•Liaison with Patient Relations, Quality Improvement staff, Patient Safety Officers, Medical Directors, Chief Nursing Officers, UW Claims Managers, and health professionals to respond to patient grievances involving alleged patient harm related to quality of care or allegations of lack of informed consent. Collaborate as needed with UW compliance officers regarding patient privacy complaints and bill waivers.
•Collaborate closely with Patient Relations staff within the UW Medicine entity and/or Health Sciences Schools to ensure the timely review, acknowledgement, and response to patient grievances within the Policies & Procedures of the entity.
•Refer patient grievances that are not resolved to the Grievance Committee as required.
•Develop responses to patient grievances in consultation with the involved health professionals and their clinical leadership to ensure patient satisfaction, integration with entity quality improvement and peer review processes, and compliance with CMS and DOH standards.
•Collaborate in the review or conduct a review of events involving patient harm under the auspices of the relevant QI Committee to identify quality improvement opportunities. As a part of the QI review process, identify potential professional liability exposures and report to the UW Liability Claims Manager. Document reviews, including:
oIdentification and preservation of relevant entity Policies & Procedures related to the event.
oInterviews and/or reports obtained from the health professionals involved in the quality improvement review of event.
oPreservation of equipment or other evidence within the established Policies & Procedures of the entity.
oMedical literature searches.
oMedical record reviews.
oConsultation with the Attorney General’s Office as necessary.
•Participation on committees, task forces, and in risk management education programs as assigned, including preparation of materials for discussion at committee meetings such as UW Medicine or entity Risk Management and quality improvement committee meetings and independent preparation and delivery of educational materials and programs.
•Conduct clinical risk assessments to identify the potential for patient harm and to recommend strategies to mitigate them.
•Demonstrate knowledge and understanding of patient privacy rights. Maintain confidentiality of all medical, financial, or other sensitive materials and information in printed, electronic, or verbal form, which may jeopardize the privacy of patients. Access and use the minimum necessary patient identifiable information to perform job responsibilities and duties and only for authorized purposes.
•Demonstrate knowledge and understanding of and maintain confidentiality of employee information and UW Medicine strategic plans and initiatives, financial information or other sensitive materials and information in printed, electronic or verbal form, which may jeopardize employee rights or organization’s operations. Access and use the minimum necessary employee and organization information to perform job responsibilities and duties and only for authorized purposes.
Each Risk Manager is assigned clinical areas for which they have primary responsibilities for developing relationships and providing risk management support for events, consultation, and educational programming.
•Master's Degree (MPH or Nursing preferred).
•3-5 years’ experience managing professional liability events in a healthcare risk management setting and/or professional liability claims experience.
•3-5 years’ experience as a clinician preferred and/or equivalent work experience in a healthcare setting.
Equivalent education and/or experience may substitute for minimum requirements.
•Experience-based knowledge of medical professional liability exposures and laws, investigation and negotiation techniques.
•Thorough knowledge of the principles and practices of Risk Management.
•Effective and professional oral and written communication skills
•Proven ability to organize and analyze data and to problem-solve using continuous quality improvement techniques to improve processes and outcomes.
•Demonstrated familiarity and ability to use Word & Excel and similar software products independently.
•An understanding of health care regulations and how they affect patient care delivery systems.
•Experience-based knowledge of customer service techniques.
•Proven ability to work effectively in a team environment with rapidly shifting priorities.
•3 years’ experience working with the public to resolve disputes or equivalent work experience.
•3 - 5 years’ experience developing and using databases to report information.
•Risk Management credentials, such as the Associate in Risk Management (ARM) or Chartered Property Casualty Underwriter (CPCU) or certificate program in Healthcare Risk Management (CPHRM).
•Experience working on and implementing strategies related to equity, diversity, and inclusion.
•Office-based work primarily with heavy use of telephones and computers. Some travel required between clinical sites.
•Position is eligible for a hybrid work environment.
CONDITIONS OF EMPLOYMENT
The application process for UW positions may include completion of a variety of online assessments to obtain additional information that will be used in the evaluation process. These assessments may include Work Authorization, Cover Letter and/or others. Any assessments that you need to complete will appear on your screen as soon as you select “Apply to this position”. Once you begin an assessment, it must be completed at that time; if you do not complete the assessment, you will be prompted to do so the next time you access your “My Jobs” page. If you select to take it later, it will appear on your "My Jobs" page to take when you are ready. Please note that your application will not be reviewed, and you will not be considered for this position until all required assessments have been completed.