Director of Patient Claims & Risk Management

MedStar Health
United States, D.C., Washington
Nov 08, 2024
General Summary of Position Reporting to the Assistant Vice President of Quality and High Reliability with matrix reporting to the Vice President for Risk Management Services for MSH., the Director of Risk and Claims Management directs, designs, implements and maintains the Risk Management Program in order to reduce incidence and magnitude of loss to the Hospital. Responsible for managing MWHC's medical professional liability including those involving any MWHC associate, including employed physicians. Responsible for fully supporting MedStar's captive insurance program, Greenspring Financial Insurance Limited (GFIL), as well as MedStar's early intervention, patient safety and loss prevention programs. Protects the Hospital's assets through risk and claims management and loss control and a focus on patient safety. These functions are performed in accordance with all applicable laws and regulations and MWHC's and MedStar Health's philosophy, policies, procedures and standards. Primary Duties and Responsibilities Develops, and upon approval, implements and administers hospital internal risk management and patient safety programs in accordance with all federal, state and regulatory agency requirements. Participates in and directs the investigation, documentation and assessment of all actual and potential liability risk exposures (which include Patient Safety Events (PSEs)) for the hospital. Designs and implements programs and strategies to minimize or eliminate risk exposures. Analyzes data and reports to hospital administration and our Risk Management Department on a regular basis regarding Risk Management program, trends, and current issues. Develops, presents and evaluates educational programs relating to risk management theory, current issues, regulations and incident prevention. Selects, trains, and orients personnel who will include risk management consultants and a risk management data analyst. Monitors and supervises risk management and claims work, evaluates performance, and initiates or recommends personnel action such as merit increase, promotions, and disciplinary actions. Maintains ongoing communication with associates to review programs, provide feedback, discuss new developments, and exchange information. Actively participates in the medical professional and general liability claims management program for the hospital and under the direction of the MedStar Health Risk Management Department. With guidance of MSH VP, Risk Management, oversees the handling of claims at MWHC including reserves, communication with patients and or families, documentation, evaluation, and patient bill holds. Works with hospital leadership regarding decisions to waive bills in connection with a risk event or an adverse event. Works closely with the MedStar VP, Risk Management to manage financial aspects of the MedStar's medical professional liability and corporate general liability claims program including establishing and maintaining a sound claims-reserving program that ensures that liability exposure is timely and adequately recognized and recorded. Develops and maintains ongoing positive relationships with insurers, attorneys, mediators, legislators, and other constituents; takes a leadership role in broader tort reform efforts both locally and nationally. Responsible for developing and maintaining a strong positive working relationship with MWHC, including hospital president, MWHC senior vice president of Medical Affairs regarding all aspects of claims and litigation management, keeping them fully informed regarding the status of claims or suits. Routinely provides presentations to the Chief Medical officer, Chief Nursing Officer, Chief Operating Officer and Chief Quality Officer on significant cases. Conducts training for residents, physicians, nurses and other clinical staff regarding risk management strategies, appropriate documentation in medical records, disclosure conversations with family members and other risk and claims management topics. Minimum Qualifications Education Jurisprudence doctorate required Bachelor's degree in Nursing preferred Experience 5-7 years required Licenses and Certifications Licensed Attorney (varies by state) required RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred Knowledge, Skills, and Abilities Excellent oral and written communication skills, including presentation presence. Demonstrates strong organizational prioritization and delegation skills while working with minimal supervision. Ability to form strong working relationships with both clinical and administrative leadership. The ability, interpersonal skill and empathetic demeanor to be able to successfully connect with patients and their families and MedStar staff, including nurses and physicians, at times of high stress. Ability to identify, analyze and evaluate complex clinical and legal problems and recommend solutions. Able to make independent and timely decisions involving complex situations. Possesses the ability to work as an effective member, at times the leaders, of multiple teams. Solid judgment, conceptual and anticipatory skill s with a proven ability to think creatively and be flexible in order to meet all challenges. Proven high level of integrity and personal ethics. This position has a hiring range of $131,496.60 - $243,256.00