Director, Risk Management (Bakersfield)

Adventist Health

Bakersfield, CA

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JOB DETAILS

SKILLS

Administrative Management, Analysis Skills, Billing, Claims Management, Claims Processing, Clinical Medicine, Clinical Nursing, Consulting, Data Analysis, Establish Priorities, Failure Mode and Effects Analysis (FMEA), Focus Groups, Healthcare, Home Care, Hospice Care, Hospital, Insurance, Leadership, Legal, Litigation, Maintain Compliance, Medical Equipment, Negotiation Skills, Nursing, Organizational Development/Management, Past Due Accounts, Patient Care, Patient Safety, Performance Management, Pharmacy, Problem Solving Skills, Process Management, Risk, Risk Analysis, Risk Management, Safety Compliance, Surveillance, Time Management, Training Program, Training/Teaching, Trend Analysis

LOCATION

Bakersfield, CA

POSTED

3 days ago

Job Description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Is responsible for organization administrative and risk management activities which may include, but may not be limited to: identifying, examining and responding to risk-related issues and complaints involving the organization and its affiliates; managing or assisting in risk related reviews to prevent financial loss, improve safety, and ensure compliance. ; collaborating and consulting on grievances, complaints, or concerns that have risk management implications; monitoring organizational event reporting with primary focus on incidents involving harm or potential liability and working with Patient Safety on trending to identify opportunities for improvement; managing and analyzing risk management information data; proposing, recommending, and implementing solutions and resolutions to risk-related issues and events; following up on the implementation and impact of proposed solutions and resolutions; coordinating communication, disclosure, and early resolution after a safety event; having a general knowledge of organizational insurance programs and resources and supports Claims team in managing the organization's insurance program; interfacing with internal and external legal defense counsel. Provides or assists in risk management training and education programs; identifies experts and topics that promote management of risk; complies with risk management standards for purposes of accreditation, regulatory, and statutory compliance with the objective of promoting and enhancing patient and employee safety, evidence based and safe care, and minimizing losses to protect the assets and reputation of the organization.

Job Requirements:

Education and Work Experience:

Bachelor's degree in Nursing or other clinical field, risk management, legal or other related field: Required
Master's degree: Preferred
Seven years' experience in healthcare or general risk management: Preferred
Five years' leadership experience: Preferred

Licenses/Certifications:

Certified Professional in Healthcare Risk Management: within two (2) years of hire

Essential Functions:

Has oversight of Risk reviews of events and complaints that pose organizational risk and assists in appropriate responses. Participates in patient safety event review meetings and conduct necessary follow up. Directs and ensures efficient and adequate review analysis, and follow up are completed for high harm and potential compensable events (PCEs).
Analyzes event reporting data and makes recommendations for future review action. Contributes and participates in activities designed to reduce risk exposure and improve safe patient care (e.g. Cause Analysis, Failure Mode Effects Analysis (FMEA) and performance improvement teams). Facilitates risk assessments as needed to proactively identify and evaluate areas of risk. Acts as a liaison and resource to market Risk Management to assess risk exposures in specific clinical and other situations (e.g. Facilities, Safety, Nursing, Pharmacy, Security, and Patient Relations). Oversees reporting requirement of medical device and equipment failures. Participates as member of various organizational councils/committees to provide risk management perspective and input for purposes of managing organizational risk and promoting safety activities.
Analyzes and monitors claims trends and develops risk mitigation activities and solutions in conjunction with market Risk Management, Claims team, and Legal department. Manages claims process and ensures timely production and submission to internal and external legal counsels. Coordinates with Claims team and internal and external legal counsel to successfully manage, mitigate, and resolve claims. Oversees collection and dissemination of confidential claims information and data to authorized individuals. Oversees and reviews periodic risk management claims reports as needed. Coordinates the timely and accurate response to inquiries for claims history and coverage information. Monitors evidence preservation (e.g. surveillance video, equipment, etc, and/or litigation holds). Attends trial as site representative as directed by internal and external legal counsels. Recommends payment for replacement of lost property after claims evaluation. In collaboration with Claims team and internal and external legal counsels, negotiates settlement of small claims within administrative authority and advises billing department of appropriate action for unpaid accounts involved in litigation. Safeguards documents obtained or developed for cause analysis to ensure documents/proceedings are protected from discovery.
Develops risk management program, policies and procedures and enhances existing risk management programs, policies, and procedures consistent with established organizational philosophies and values
Collaborates with various departments to analyze data (e.g. complaints, grievances, claims, lawsuits) to identify priority topics and audiences for targeted training and education. Utilizes external data (local, state, national) to identify high-risk topic areas and focus groups for targeted education. Offers risk educational program on a regular basis and as requested including organization-wide presentations as well as specialty specific.
Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Adventist Health participates in E-Verify. Visit for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

About Us

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

About the Company

Adventist Health

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