Director, Risk Management (Legal Services)

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor's degree in Business Administration, Healthcare Management, Law, Public Health, Nursing or other healthcare-related field.

EXPERIENCE:

1. Five (5) years of management experience in a healthcare setting.

2. Three (3) years of experience in a related field, including risk management, quality improvement, and/or claims management.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Master's degree in Business Administration, Healthcare Management, Law, Public Health, Jurisprudence, or an approved Nursing Program, or other related healthcare field or equivalent experience.

2. Certified Professional in Healthcare Quality (CPHQ), Certified Professional in Healthcare Risk Management (CPHRM), JD; Registered Nurse, or other healthcare professional.

EXPERIENCE:

1. At least 3 years' experience in Healthcare Risk Management, including experience with Enterprise risk management, legal, claims management, CANDOR or other disclosure and apology program, and conducting proactive clinical risk assessments. Experience in an academic medical center preferred.

2. Experience in leading and building teams and relationships with stakeholders including medical staff.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Develops and maintains a Risk Management plan for West Virginia University Hospitals, which includes: J.W. Ruby Memorial Hospital; Fairmont Medical Center; WVU Children's Hospital; WVU Heart Institute; WVU Eye Institute; WVU Rockefeller Neuroscience Institute, Mary Babb Randolph Cancer Center, Chestnut Ridge Center (inpatient mental health); United Summit Center (outpatient mental health); Center for Hope and Healing (residential addiction recovery); and various clinics operated by WVUH.

2. Identifies, evaluates risk, and coordinates corrective action implementation related to risk issues. This includes collaboration of the organization's occurrence reporting system. Collects, evaluates, and maintains data concerning patient injuries and other risk-related data to identify potential liability cases. Collaborates in the identification and implementation of corrective action plans where appropriate. Review attorney request for medical records and submits to Legal and submits and cases of potential liability to the litigation team.

3. Develops, implements, maintains, and executes, with the assistance of WVUH Administration, WVUHS Quality, WVUHS Legal Services, and others, the CANDOR program, or other formal disclosure and apology program. Includes education and training of faculty and staff; drafting of policies and procedures for implementation, application and execution of the program; monitors events appropriate for application of the program; monitors the operation of the program; develops tracking system for those events submitted to the program and resolution of those events; provides refresher education and training to faculty, staff, administration and new hires; develops plan to provide education and training to other WVUHS hospitals about CANDOR or other formal disclosure and apology program.

4. Provide on-call coverage 24/7 for responding to physician, clinical staff, and leadership risk management consultation, responds as necessary to catastrophic clinical events or any other situation that significantly impact the operations of the organization, with the assistance of other Risk Management department or Legal Services department personnel as necessary.

5. Implements, leads, and maintains WVUHS medical device recall system.

6. Provides oversight and management for the West Virginia University Health System Risk Management Affinity Group.

7. Provides and/or coordinates intervention and education related to risk management issues to promote quality patient care and services and a safe work environment including but not limited to performing or commissioning risk assessments, creating action plans from findings of risk assessments, and monitoring progress on action plans.

8. Provides assistance to the WVU Medicine Enterprise Risk Management Program.

9. Coordinates risk programs with hospital departments and administration. Educates and trains leadership, faculty, and staff about the risk management program and their respective responsibilities in carrying out the risk management program.

10. Participates in, investigates and provides consultation for root cause analysis, patterns, or trends that could result in compensable or sentinel events. Provides leadership in the identification and implementation of corrective action plans where appropriate.

11. Participates in or facilitates committees or task forces related to risk management, safety, and quality improvement, including but not limited to Falls Prevention; Patient Safety; QEC; Daily Safety Huddles; and Drug Diversion.

12. Reports real and potential risk situations to the WVUHS AVP Insurance and Risk Management, AVP Senior Litigation Counsel, WVUHS VP Quality and Patient Safety, WVUH Administration and other leadership, hospital departments and committees, as appropriate.

13. Establishes monitoring methods to avoid, eliminate and/or reduce risk situations associated with the provision of patient care and services.

14. Assists in claims management activities including coordination with WVUHS Legal Services department as well as any outside attorneys retained to manage and defend hospital medical malpractice claims.

15. Monitors and maintains compliance with regulatory requirements regarding risk management.

16. Works closely with Patient Relations and Legal Services departments to reduce or limit liability by making proper and timely error disclosure when appropriate and evaluating and recommending patient billing write-offs or reductions related to errors or customer service issues.

17. Collaborates with clinical staff and management for reduction or prevention of clinical and other risks. Develops effective working relationships with clinical staff and administrative personnel to facilitate the delivery of patient care and compliance with risk management policies, procedures, and regulatory requirements.

18. Directs and manages other Risk Management employees, including hiring, discipline, performance evaluation, task assignment and monitoring, education, goal-setting and day-to-day management of the Risk Management department.

19. Develops and maintains budget for Risk Management department.

20. Performs other duties as assigned.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Must have manual dexterity to operate keyboards, telephones, and other business equipment.

2. Ability to sit for extended periods of time.

3. Long periods of standing or walking may be necessary.

4. Travel to other WVUHS entities may be required.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. General office-like setting, with some travel required to outside entities and facility based-entities.

2. Visual strain may be encountered in viewing of computer screens, spreadsheets, and other written materials.

SKILLS AND ABILITIES:

1. Proficiency in planning, coordinating, and implementing procedures.

2. Working knowledge of health care and legal systems, knowledge of regulatory and legislative matters, and a working knowledge of performance improvement.

3. Excellent verbal and written communication skills.

4. Good judgment and decision-making abilities.

5. Strong interpersonal, organizational and customer service skills.

6. Ability to work independently and as part of a team.

7. Interest in continuous learning and a commitment to staying informed on regulatory changes.

8. Attention to detail and analytical skills.

9. Comfort in handling challenging situations that may involve adverse outcomes and difficult conversations.

10. Ability to maintain a calm, professional demeanor under pressure.

11. Highly organized and action-oriented.

Additional Job Description:

Legal Services

Morgantown, WV

Scheduled Weekly Hours:

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Exempt/Non-Exempt:

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WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.