Job Description

Job Title: Sr. Risk Management Specialist
Job ID: 749173
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department: Corporate Risk Management
Location: 3600 Forbes Ave, Pittsburgh PA 15213

Description

Purpose:
Under the supervision of the Director, the function of the position is systematic management of potential as well as actual claims. Clinical data will by analyzed to determine areas of potential liability. Corrective actions will be developed with the assistance of clinical teams. The position will develop loss prevention programs in the area of professional liability to improve the quality of patient care while controlling liability exposure. This position requires critical thinking skills and the ability to provide direction. Must be able to collaborate with hospital leadership in coordinating and managing individual projects.

Responsibilities:

  • Act as a resource/consultant for staff and affiliates for questions and concerns regarding professional liability issues. Provide twenty-four hour day coverage according to the department on-call schedule.
  • Assimilate ideas and risk reduction strategies of UPMC Health System facilities into the Risk Management Program.
  • Conduct high quality in-depth multi-disciplinary investigations of occurrences, which present significant risks in the area of professional liability and share information with appropriate management and staff.
  • Coordinate Risk Management functions with the multiple disciplines and other Risk Management Peers.
  • Coordinate access to information or staff with outside legal counsel and insurance investigators.
  • Coordinate assigned professional liability legal suits with defense counsel.
  • Develop relationships within the management structure in order to facilitate investigation and feedback.
  • Develop written material for distribution to hospital staff, office practices and affiliated programs both on and off campus and present onsite educational programs.
  • Develop, with the Patient Relations staff, a coordinated approach to patient and family complaints.
  • Establish a working relationship with staff of managed care organization and office site staff to facilitate integration of practice plans into the insurance program.
  • Establish an occurrence reporting system compatible with the current system, monitoring of occurrence reports and investigation of significant events.
  • Establish files on potentially compensable events and submit to the UHCIP as appropriate. Participate in determining level of liability exposure and setting of reserves.
  • Evaluate educational programs of UPMC Health System facilities and mobilize resources for developing specific programs to address the needs of the clinical and management staff.
  • Evaluate informational requests from department heads and coordinate with the Information Systems Coordinator necessary parameters to meet the request and facilitate report preparation.
  • Gather information and requested documents to prepare draft Answers to Interrogatories, review Answers to Complaints and Interrogatories prior to Director's review and signature, schedule and attend meetings and depositions with hospital staff and defense counsel, attend trials and prepare written summaries for Director, review and present requests for settlement authority to Director.
  • Identify educational needs of the institution and develop specific educational programs for medical staff, nursing staff, allied health professional and others.
  • Identify specific needs of the office practices and develop Risk Management strategies to address those needs and act as resource for physicians and staff regarding medical legal issues involving private practice and managed care.
  • Integrate ideas of community hospitals and facilitate ideas into the UHCIP.
  • Intervene at the request of UPMC Legal Services to provide information and guidance to staff regarding subpoenas and other legal matters.
  • Maintain awareness of current legislative activity affecting Risk Management by participating in local and national professional societies. Stay abreast of Risk Management trends by reviewing appropriate literature.
  • Monitor occurrence-reporting system by analyzing and identifying trends and developing corrective action plans in conjunction with appropriate management and staff.
  • Open and maintain legal files, complete and update Case Summary Worksheets on all assigned cases.
  • Participate in Patient Safety Committees of designated areas.
  • Present legal suit summaries at Professional Healthcare Provider Review Committee. Provide necessary information relevant to issues before the committee and participate in discussions as appropriate. Facilitate dissemination of information to the appropriate departments at the direction of the HRC.
  • Represent Risk Management on multi-disciplinary hospital committees and provide statistical information and reports as required or requested. Review and evaluate information from those committees for potential liability exposure. Seek appropriate corrective action plans from involved services and provide feedback to the committees.
  • Responsible for compliance with the provisions of the Safe Medical Device Act and providing the necessary support systems.
  • Review and evaluate potential and current claims with relevant internal departments and UHCIP claims investigator and make appropriate recommendations to Director for approval or denial of requests for reimbursement or adjustments of claims.
  • Serve as liaison between the Program and non-Faculty physicians.

Qualifications

  • Bachelor of Science and a minimum of five years clinical or healthcare experience. 
  • Experience in data/trend analysis and report preparation is necessary.  
  • This position requires an individual who is skilled in both verbal and   written communication and demonstrates independence, leadership and the ability to make sound decisions. 
  • This position involves the handling of very sensitive and confidential information.

    Licensure, Certifications, and Clearances:
  • Pharmacist or Registered Nurse

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

 

Salary Range: $28.37 to $47.88 / hour

Union Position: No

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