Healthcare Risk Management Specialist

Description

The Risk Management Specialist is responsible for assessing, responding to, and educating staff about risk factors determined through review of patient/visitor incidents, clinical events, and medical records. The Risk Management Specialist may conduct investigations, track and trend incidents, and report findings to management for further investigation and corrective action.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Track and file incidents, complaints and grievance information in reporting tracking systems, and utilizes the data to create Risk Management reports for presentation to the Professional Practices Committee, ASC Medical Executive Committee, and the Board of Directors.
• Identify areas for improvement based on review of reports received
• Respond to patient complaints and grievances received by the Risk Management Department.
• Coordinate Termination of Care request activities, to include any necessary research and consultation with the Medical Director, creation and mailing letters, responding to patient inquiries, responding to patient appeals, and maintaining documentation.
• Prepare written responses to grievances in compliance with regulatory requirements, to include any necessary research and consultation with the Medical Director and/or SVP Administration in creation and mailing of letters and maintaining documentation. 
• Coordinate with billing office to address any necessary billing adjustments.
• Ensure living wills and other related documents are uploaded timely into EMR system.
• Complete provider onboarding for new physicians and med-level providers:

1. Conduct NPDB and AMA search and provide copies to necessary parties
2. Obtain malpractice face sheets from insurance carrier and provide to Provider Enrollment
3. Obtain copies of medical license, DEA, board certifications, and verify accuracy of information provided on application
4. Obtain malpractice tail certification from physician for previous practice
5. Maintain documentation of completed orientation with Risk Management team.

• Routinely assess Risk Management policies and processes; make recommendations regarding changes/updates.
• Develop and train risk topics, internal process changes, and regulatory requirements for staff.   
• Provide general Risk Management training to new staff as part of New Employee Orientation.
• Coordinate conferences and meetings. Prepare agenda, take minutes, prepare and archive minutes, and prepare information packets.
• Assist in risk claims administration, including: 

1. reporting incidents to insurance carriers  
2. coordination of communication with claimants, attorneys, insurance companies and others 
3. immediate intervention and documented investigation of all claims 
4. maintenance of claims files 

• Assist with recording, collecting, documenting, maintaining, and providing to MCC attorney any requested information and documents necessary to prepare testimony in pending professional or general liability litigation against MCC personnel.
• Respond as a member of the Manned Response Team (MRT).
• Performs other related duties as assigned. 

CORPORATE CULTURE RESPONSIBILITIES

• Follow established corporate and department-specific policies and procedures.
• Attend all corporate and department-specific required training.
• Uphold MCC’s Purpose, Values, and Vision.
• Abide by MCC’s Corporate Culture Responsibilities. 
• Perform other duties as may be assigned cheerfully and willingly.

Requirements

EDUCATION/EXPERIENCE REQUIREMENTS

• Minimum education requirement is high school diploma or GED.
• Associates degree preferred.
• Maintains Florida license or a certification in healthcare field.
• Previous Healthcare Risk Management experience preferred.

KNOWLEDGE, SKILLS AND ABILITIES

• Ability to work with the public, co-workers and other employees with diplomacy, tact, and confidentiality.
• Display customer services skills, strong interpersonal skills, close attention to detail, and excellent verbal and written communication skills.
• Professional demeanor and recognition of privacy considerations for patients and families.
• Be a person of integrity and character, willing to embrace change and make a positive impact in the lives of patients and co-workers.
• Ability to work with staff members at all levels of the organization in a cooperative, team-oriented manner.
• Display ability of giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
• Five years of experience in customer service and/or patient relations in a healthcare setting, with experience handling patient complaints.
• Advanced ability utilizing MS office suite, specifically Outlook, Excel and Word.
• Ability to prioritize work projects, independently manage duties and resolve conflicting deadlines. Able to work effectively in a fast-paced environment.
• Ability to multi-task and prioritize high level projects and manage time effectively.
• Proficient in use of English language both in written and verbal communication.
• Must be able to communicate with individuals of varying socio-economic backgrounds.
• Must be able to operate telephone and two-way communications devices.

PHYSICAL REQUIREMENTS OF THE ESSENTIAL JOB FUNCTIONS

• Strength (Lift/Carry/Push/Pull): 30 lbs maximum
• Standing/Walking: Frequently; activity exists ¾ of the time. 
• Ability to work in various positions (standing, sitting, and walking).
• Using a computer: Greater than ¾ of the time.
• Talking (Must be able to effectively communicate verbally): Yes
• Seeing: Yes
• Hearing: Yes

EMOTIONAL REQUIREMENTS OF THE ESSENTIAL JOB FUNCTIONS

• Must exhibit stable work behaviors daily.
• Must possess adequate individual coping skills.
• Ability to remain calm and professional regardless of workload or time constraints.   
• Must be able to work under stress and remain calm and professional.    

WORK ENVIRONMENT

• Exposed to frequent and constant interruptions in daily functions/schedule.  
• Must be available to customers and staff throughout the day.