Manager - Risk Management - RN
Cedars-Sinai Medical Network is located in Los Angeles, California. Our dedicated professionals bring everything they have to provide the highest quality patient care to the communities they serve in the greater Los Angeles metro area. As an employee within the Cedars-Sinai Medical Network, you can expect the same high-performance standards, culture and collaboration that you would expect from the Cedars-Sinai Medical Center.
This position is responsible to support the organization, management and evaluation of all aspects of Cedars-Sinai Medical Network's Risk Management Program. This position is responsible for management of risk of financial loss to Cedars-Sinai Medical Care Foundation Affiliated Groups as well as in a consultative role to Cedars-Sinai Health Associates in the areas of general and professional liabilities under the direct supervision of the Director, Risk Management. This position assists in the identification and resolution of potential risk related to systems, processes and clinical issues. Additional primary responsibilities of this position include assisting the Foundation Privacy Officer with HIPAA and California State Privacy compliance for all Affiliated Medical Groups and physicians contracted to the Foundation.
WHY CEDARS SINAI
Exceptionally developed skills, a dedication to excellence and a desire to transcend the ordinary. This is the source of true art. It is also the foundation for the world-class healthcare provided at Cedars-Sinai. If you want to be your best, you owe it to yourself to work with the best. You'll have that opportunity when you work at Cedars-Sinai Medical Network.
ESSENTIAL JOB DUTIES:
* Provide risk management consultation to physicians and staff as needed.
* Assist in the review and summarization litigation cases, maintaining litigation files as appropriate.
* Develop a comprehensive risk management program, including clinical and administrative policies and procedures for loss prevention, loss control, and loss mitigation.
* Review organizational wide policies and procedures, when requested, for compliance to applicable Federal, California State Law, regulatory and court mandates as well as compliance to Accrediting bodies and HMOs as appropriate.
* Supports risk management activities for all providers and staff regarding high risk issues; including the following:
* Collect information to respond to subpoenas in a complete and timely manner.
* Assist in preparing physicians for depositions and court appearances prior to attorney involvement as requested.
* Assisting clinicians to meet legal obligations to patients including consent, non-compliance warnings, and appropriate documentation.
* Intervene as directed to resolve issues directly with patients and family.
* Assist in obtaining compliance with statutory reporting including abuse and suspicious injury reporting.
* Develop dashboards to trend litigations over time and develop preventive programs accordingly in collaboration with Quality Management
* Collaborates with Quality Management regarding claims denials trends for the prevention of potential litigation.
* Provide assistance to operations managers in dealing with adverse events and difficult patients.
* Provide training to all staff and physicians to ensure compliance with California Privacy and HIPAA regulations.
* Review and manage all claimed privacy breaches by physicians responding to regulatory agencies as required.
* Ability to effectively form and participate in teams of appropriate stakeholders to assess new technologies to identify and mitigate risk to the organization.
* Coordinate and participate in quarterly malpractice-carrier litigation claims review.
* Supports Operation management in reviewing administrative processes to ensure regulatory compliance and patient safety.
* Collects information to support brokers in insurance placement for professional liability, general liability, directors and offices coverage, fiduciary liability, managed care errors and omissions, and workers compensation for Affiliated Groups
* Collects information for the initial processing of first aid and workers compensation claims for physician groups.
* Conducts appropriate orientation/ training of new staff and physicians.
* California RN license and Bachelor of Science degree in Nursing or related field is recommended.
* Juris Doctor and advanced degree in health care-related field is required.
* Five (5) years of management and managed care experience, preferably in a medical group/IPA or health plan setting.
* Prior professional liability insurance risk management experience preferred.
* Strong verbal and written skills a must;
* Must have knowledge of Continuous Quality Improvement, Credentialing, Peer Review and Risk Management processes.
* Must have working knowledge of compliance with health related California health regulatory boards and processes.
* Must have basic computer skills and the ability to expand skill sets.
CONTACT OLIVIA GLAY AT OLIVIA@ASCENDHRCORP.COM TO KNOW MORE ABOUT THE DETAILS OF THIS POSITION.