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Clinical Claims Attorney 9/16/2017

Methodist Houston, TX

Company
Methodist
Job Classification
Full Time
Company Ref #
33839
Location
Houston, TX
Experience
Mid-Career (2 - 15 years)
Job Type
Regular
AJE Ref #
579539195

JOB DESCRIPTION

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Job Summary

Performs claims management from incident responses to mediation or trial: works closely with defense counsel and system health care professionals to mitigate and defend claims. Secures appropriate authority to resolve claims. Serve as primary employee contact for risk issues, Reviews claims for liability determinations. Perform risk reduction activities. Takes 24 hour call on rotating basis.

ICARE VALUES
System and department specific ICARE values

INTEGRITY: We are honest and ethical in all we say and do.
COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
ACCOUNTABILITY: We hold ourselves accountable for all our actions.
RESPECT: We treat every individual as a person of worth, dignity, and value.
EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

JOB RESPONSIBILITIES
PEOPLE 20%
1. Provide claims reports to the internal and external audiences including the actuary and excess carriers, executives and committees.
2. Present Risk Management in-services to staff within and outside Department.
3. Serves on committees as needed and prepare and present reports on legal and claims issues.
4. Take 24-Hour call on rotating basis.

FINANCE 15%
1. Evaluate the merits of claim; analyze damage potential; set accurate indemnity and legal claim reserves.
2. Review legal bills and either approve payment or resolve any discrepancies.
3. Secure settlement authority; coordinate payment of settlements and obtain releases.

QUALITY/SAFETY 20%
1. Investigates claims as assigned including record reviews and personal interviews of fact witness. Prepare report of findings. Attend and participate in root cause analysis as required. Handles all claims, which may include professional liability, employment liability, directors and officers liability, premises liability, general liability and others as assigned.
2. Review reports of device related occurrences and if required, investigate further. Prepare reports to manufacturers and food and Drug Administration as required by the Safe Medical Devices Act; educate staff about the Act s requirements; write reports on related activities.
3. Follows all safety rules while on the job. Reports accidents promptly and corrects minor hazards.
4. Maintain timely, accurate and complete files on claims and events.

SERVICE 25%
1. Primary responder to inquire from clinical and non-clinical staff about incident-specific situations and legal issues.
2. Assures accurate, complete and timely responses to discovery.
3. Schedule and attend pre-deposition meeting and depositions when necessary. Assure that all information is available at meeting. Provide support to necessary personnel being deposed. Assist defense counsel with preparation of personnel being deposed.
4. Monitor the work of defense counsel; establishes a defense budget for expenses and attorney fees.
5. Provide primary legal defense attorney work for cases filed in Justice or Small Claims Court.
6. Review medical records and fact scenarios to make primary determination of liability issues.

GROWTH/INNOVATION 20%
1. Settle claims pre-suit within stated limits of authority when appropriate; may require negotiations with complainants or his/her attorney. Draft and/or revise settlement agreements as needed.
2. Represent Methodist at mediations and arbitrations. Represent Methodist as corporate representative at trials, hearings and meeting when appropriate.
3. Identify Risk Reduction opportunities; implement within authority.
4. Conducts accurate legal research and analysis.

This position description is not intended to be all inclusive, and the employee will also perform other reasonably related business duties as assigned by the immediate supervisor and other management as required. Houston Methodist l reserves the right to revise or change job duties and responsibilities as the need arises.

EDUCATION REQUIREMENTS
Doctor of Jurisprudence degree

EXPERIENCE REQUIREMENTS
Minimum 2 years experience in direct patient care as a licensed healthcare provider, preferably as a registered nurse.
Experience managing claims, risk management or work in litigation preferred.
Knowledge of hospital operations preferred.
Working knowledge of risk management information systems preferred. Experience processing large quantities of file material preferred.

CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED

Member of the Texas Bar in good standing and current licensure in Texas
Licensure in good standing for relevant clinical degree.

SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

1. Excellent verbal and written skills, persuasive skills.

2. Ability to maintain composure when dealing with difficult situations.

3. Proven interpersonal skills; able to interact effectively with persons with varying backgrounds, ability to function as a team member

4. Ability to quickly discern key issues to create a plan for quick claim evaluation and direct outside counsel to most efficiently manage litigation.

5. Analytical; makes sound decisions based on analysis of the situation and the law.

6. Superior organizational skills; must be able to handle heavy workload.

7. Demonstrated computer efficiency in various software applications including word processing, spreadsheets, database systems and risk management systems, and experience in formulating database queries.

8. Knowledge of medical terminology is preferred.
Equal Employment Opportunity

Houston Methodist is an Equal Opportunity Employer.

Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.

VEVRAA Federal Contractor priority referral Protected Veterans requested.

Company Profile

Since its founding in 1919, Houston Methodist Hospital has earned worldwide recognition. Houston Methodist Hospital is affiliated with the Weill Medical College of Cornell University and New York-Presbyterian Hospital, one of the nation's leading centers for medical education and research. Houston Methodist is consistently ranked in U.S. News & World Report s Best Hospital list and was recently named the number one hospital in Texas. FORTUNE magazine has placed Houston Methodist on its annual list of 100 Best Companies To Work For since 2006. Houston Methodist Hospital directs millions of research dollars into patient care and offers the latest innovations in medical, surgical and diagnostic techniques. With 1,119 licensed beds, 67 operating rooms and over 6,000 employees, Houston Methodist offers complete care for patients from around the world. APPLY.