Risk Management Program Lead bei Stamford Health, Inc.

1. Assist Director in managing day-to-day operations of the department, serving as the initial operational support person to the Senior Risk Associate(s) and/or Risk Associate(s) seeking assistance with question(s) or risk management guidance. 
2. Establish and maintain positive relationships with patients, visitors, physicians and other employees. Interact professionally, courteously, and appropriately with patients, visitors and other employees. Behave in a manner consistent with maintaining and furthering a positive public perception of Stamford Health and its employees.
3. Contribute to and participate in the Performance Improvement and Quality Improvement activities of the assigned department. Contribution and participation include data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement (CQI) teams, consistent adherence to the specific rules and regulations of the Stamford Health System (SHS) to include, but not be limited to:  (a) Safety and Security Policies, (b) Risk Management: Incident and Occurrence Reporting, (c) Infection Control Policies and Procedures and (d) Patient and Customer Service.

       4. Risk Management Functions

• Assist RM Leadership in the smooth operation of the Department.
• Respond to inquiries or reports regarding potential or actual occurrences in the SHS that implicate medical, legal, ethical or loss control issues that could be potentially compensable and prepare reports for monthly Claims Committee.
• Oversee analysis and evaluation of occurrence reports generated by employees or physicians, departments and individuals responsible for Medical, Nursing and other departments in an effort to determine the significance and possible compensability and reportability of events. 
• Assist departments in determining appropriate corrective actions involving risk and medical error reduction.
• Undertake investigation and follow up of occurrences involving risk management, quality of care issues or professional or general liability exposure.
• Review and evaluate requests for medical information and/or records to determine appropriate authority of request and screen potential requests for litigation implications.
• Develop and track department metrics and create reports as directed by RM Leadership. Provide analysis of department trends and risk activities. Oversee team to assure reports, including Power Point slides for various committees, underwriter community and Healthstar Board requested by RM Leadership are completed accurately and on time. 
• Assure monthly metrics are documented in the SHS department scorecard, Stamford Health Medical Group scorecard and Enterprise scorecard.
• Supervise maintenance of multiple databases used within department. Examples of databases include but are not limited to: RLDatix occurrence reporting system, claims analysis and Apparent Cause Analysis. 
• Oversee and assist with timely completion of reports which provide analysis of department trends and risk activities. Examples of these reports include: specific department reports, HSS Collaborative report, Chair Reports, Stamford Health Medical Group report for SHMG leadership.
• Assist in the investigation and preparation of case summaries of presentation at Clinical Review and/or Apparent Cause or Root Cause Analysis meetings.
• Participate in Apparent Cause or Root cause Analysis team meetings.
• Develop agenda, number and prepare pre-claims packet and ensure it is sent out to participants at least two days prior to meeting. Review and approve the final agenda and packet with Manager, Risk and Insurance Operations, prior to it being sent out to ensure smooth operations of the Claims Committee. In the absence of the Director, the RM Program Lead will lead the Claims Committee and assure that the Senior Risk Associate(s) or Risk Associate(s) review minutes for accuracy prior to final review by RM Program Lead.
• Assure that physician or nursing leaders on the Claims Committee are alerted, in advance of any potentially compensable events (PCEs) or claims that they may be asked to discuss at the monthly meeting ang provide them any requested documentation as needed.
• Send concerning PCEs or claims to Manager, Medical Staff Peer Review, for review at the appropriate peer review committee.
• Assist in PCE or claim reporting, send any necessary litigation hold memos and assist in any additional work or verification activities as requested by RM Leadership.
• Lead serious event review panels (SERPS) on a rotating basis.
• Oversight of development and implementation of RM educational plan which would include RLDatix training, as well as risk identification and mitigation recommendations. Part of this responsibility would be to evaluate effectiveness through RLDatix submission numbers or feedback from staff during rounding. RM Program Lead would re-evaluate the plan on an annual basis.
• With assistance from Director and RM team, manage the oversight of yearly projects sponsored by RM. Examples: RM Grant Program; CANDOR.
• May deliver presentations to Hospital or SHMG groups at discretion of Director. Examples include:  Organizational Briefing, SHMG Practice Managers’ Meeting or other ad hoc forums.
• Take risk management call on a rotating basis as assigned by department.
• Oversee orientation done by the Department for new employees, nursing, ambulatory services, Medical Group, physician orientation or any other orientation requested by Director. 
• Assist Director in monthly review of Attorney Request for Records list provided by Health Information Management to assure any potential liability is identified.
• Participate in professional organizations, representing Stamford Health in a positive light, collaborate with external resources to identify and develop improvements for the RM Program. 
• Interface with the medical records department as necessary to ensure efficient processing of inquiries from regulatory agencies and legal representatives of patients. 
• Responsible for training and education of new Senior Risk Associate or Risk Associate staff.
• Perform other related duties as assigned or requests in order to maintain a high level of service.
• Complete required continuous training and education, including department specific requirements.
• Demonstrate professional work behavior by following Service Standards and Succes factors.
• Comply with departmental and organizational policies and adheres to external agency requirements (ex: maintain licensure).
• Assist departments in determining appropriate corrective actions involving risk and medical error reduction. 
• Provide written critical analysis of cases and recommend policy or procedural changes as warranted. 
• Follow up on risk reduction strategies and corrective action plans in response to sentinel events or quality of care issues. 
• Interface with other departments to address patient care issues or complaints promptly and effectively.
• Develop and maintain programs for tracking and trending significant and/or reportable occurrences and professional practice concerns.
• Coordinate or participate in performance improvement committees, as necessary.

       5. Performance Improvement Functions:

• Provide written critical analysis of cases and recommend policy or procedural changes as warranted. 
• Follow up on risk reduction strategies and corrective action plans in response to sentinel events or quality of care issues. 
• Interface with other departments to address patient care issues or complaints promptly and effectively.
• Develop and maintain programs for tracking and trending significant and/or reportable occurrences and professional practice concerns.
• Coordinate or participate in performance improvement committees, as necessary.

       6.  Regulatory Functions:

• Assist the ED, Regulatory Affairs and Compliance Programs, Administrative Director, Regulatory Affairs or Senior Regulatory Affairs Specialist, by providing any occurrence reports, investigative notes or documents and assisting, as needed, in reporting to the Department of Public Health pursuant to legislative and regulatory guidelines. 
• Provide assistance to other departments under the supervision of the Eds, Director, RM or Regulatory Leadership with preparation for regulatory surveys and site visits. 
• Within Administrative policy guidelines or at the direction of the RM or Regulatory Leadership, coordinate or participate in meetings with regulatory agencies. 
• Coordinate efforts to provide assistance to regulatory agencies in response to inquiries or requests for information and/or medical records consistent with Department and Hospital policy. 
• Assist the Regulatory or RM leadership, as needed, in interfacing with regulatory agencies, in MEDSUN submission and other issues that may arise. 

       7.  Educational Functions: 

• Provide in-service training at the new employee, nursing or other orientation sessions and other venues, as requested by RM Leadership regarding risk management issues and department functions.
• Participate in and/or attend educational seminars and conferences at the request of the RM leadership. 
• Assist with staff educational programs involving patient safety, including, but not limited to: medical injury prevention, documentation, informed consent policy and procedures, occurrence reporting, high level Joint Commission reporting and reporting involving other regulatory agencies, Guidelines for Withholding or Removing Life Support, Do Not Intubate/Do Not Resuscitate policies and procedures, Health Care Representative/Proxy policies and procedures, and other programs as requested or as determined by the Department of Risk. 

• Registered Nurse is required.
• Bachelor’s Degree in Nursing is required from an accredited college is required, with a Master’s Degree preferred.
• A minimum of 5 plus years clinical nursing experience required.
• Ability to maintain multiple databases required.
• Mastery of quality improvement methods and data analysis is required.
• Ability to develop and produce regular and ad hoc department reports utilizing various risk, insurance and regulatory databases.
• 3 plus years relative risk experience preferred.
• 4 plus years leadership experience preferred. (Can be leading programs, training, etc. Does not have to be specific to Risk Management).
• CPHRM required. If no certification on hire, must complete within 1 year of hire.
• Excellent written, oral and communication skills are essential.
• Demonstrated organizational skills are essential.
• Experience in developing reports and conducting educational programs and presentations.
• High level of competency with computer software including MS Office, Excel and PowerPoint is required.