Director of EMH Risk Management - Legal Services - Flex - 1st Shift

JOB SUMMARY

The Risk Manager & Privacy Officer shall provide risk oversight to the Organization to proactively prevent and/or minimize diverse risk exposures throughout the System which include but are not limited to:

1. Recommendations for appropriate transfer of risk and risk finance options.
2. Claims analysis, management and administration of potential claims, exhibiting competence and knowledge of legal and regulatory compliance issues, integration and implementation of new technologies, i.e., electronic information systems, etc.
3. Preservation of financial and human capital.
4. Completion of appropriate risk assessments.

The Privacy Officer advocates and protects patient privacy by serving as a key privacy advisor for Associates, medical staff, and patients; handling disputes and, in collaboration with HIM, managing patient requests regarding medical records and protected health information.

The Privacy Officer shall oversee all system activities related to the development, implementation, maintenance of and adherence to the Organization’s privacy program in compliance with all industry standards, federal and state laws including but not limited to the:

1. Privacy, confidentiality and security of personal and/or protected health information;
2. Collaboration with appropriate individuals, committees and assigned workgroups to develop system wide policies and procedures for the privacy program;
3. Guiding the preservation, security and retrieval of data stored on internal and external electronic information systems;
4. Provision of leadership for the system privacy program reporting to appropriate committees and the board on issues of privacy status, security of internal and external electronic information systems, notification and resolution of complaints regarding possible violations of privacy practices and identification of corrective actions taken to improve enterprise privacy processes;
5. Authorization to serve as liaison to regulatory and accrediting bodies for matters relating to privacy and security of protected health information, in collaboration with the Chief Information Officer and General Counsel; and
6. Development of education and training programs for board members, senior leadership, healthcare providers, Associates, patients and customers that address privacy practices specific to access, use and disclosure of patient health information.

Under the direction of the General Counsel and general oversight of the Chief Financial Officer, the Risk Manager & Privacy Officer shall identify, and work with others to mitigate potential risks to the Organization. Exhibits the F.I.R.S.T. values (Friendliness, Innovation, Respect, Service and Trust).

ESSENTIAL FUNCTIONS,

DUTIES AND RESPONSIBILITIES

• OPERATIONAL EFFECTIVENESS:
• Establish, implement and monitor a system wide risk management program for Ephraim McDowell Health in accordance with and in support of the Organization's strategic, operational and financial goals and objectives.
1. Identify and facilitate ongoing, comprehensive operational risk assessments. Provide review and risk analysis of Organizational, patient care and departmental policies, procedures and practice protocols.
2. Assess the inter-relatedness and inter-dependence of isolated risk and liability exposures within the Organization.

1. Participate on the Risk Management Committee of the Board, Corporate Compliance Committee, Quality Council(s) Safety Committee, and other System-Wide committees as directed. Provide trend, and exposure reports to Risk Management Committee of the Board.
1. Prepare written reports and summaries to address the annual corporate compliance work plan;
2. Submit Risk Management Reports to Quality Council(s) summarizing occurrence trends and/or event variances; and
3. Prepare monthly reports to submit to the Safety Committee(s) addressing regulatory and accreditation requirements.
2. Manage insurance coverage, risk retention and risk transfer options under the direction of the Chief Financial Officer, with input from General Counsel.
3. Review insurance programs and coverage with brokers, agents, carriers and corporate leadership in order to achieve the business objectives of the Organization.
4. Facilitate and conduct appropriate, due diligence on brokerage and vendor services, and all lines of insurance, in collaboration with the Chief Financial Officer.
5. Coordinate and facilitate insurance and risk finance application(s) and renewal activities in collaboration with the Chief Financial Officer, General Counsel, brokers, agents, carriers and underwriters to compile and submit required applications annually.
6. Prepare and complete all applications and documentation for initial purchase and renewal of coverage.
7. Prepare and submit invoices for premium payment and losses to Accounts Payable.
8. Notify insurance carriers of any changes that may affect coverage or premium costs.
9. Provide oversight to insurance coverage and risk finance requirements to negotiate optimum premium rates and contracts.
10. Assess risk, in collaboration with the Chief Financial Officer and General Counsel, to establish appropriate risk retention limits, insurance options and risk transfer recommendations to ensure adequate professional liability coverage to all employed physicians, licensed providers and other system professionals.
11. Maintain insurance files for all lines of insurance.
12. Secure certificates of insurance from carriers as requested and/or required.
13. Respond to inquiries and queries from the Chief Financial Officer, the Organization’s Leadership and program administrators.
14. Maintain regular communication with brokers, agents, underwriters and claim management providers to ensure comprehensive assessment and cost analysis of the Organizations’ strategies to protect the financial objectives of the Organization.
15. Provide oversight for the management, evaluation and loss analysis of claims asserted against the Organization, in collaboration with General Counsel; Meet all reporting and communication requirements of individual carriers, and third party administrators for pre-suit claims, in collaboration with General Counsel. Coordinates pre-suit claim management activities in collaboration with General Counsel.
16. Conduct claim management for pre-suit claims and administrative support for claims asserted against the Organization in collaboration with the Organization’s General Counsel. Secure and maintain medical records, and claim documentation as directed under regulatory guidelines, statutes of limitation and the Organization’s record retention policy.
17. Conduct and facilitate risk identification, cost of risk and loss analysis reports in collaboration with the Chief Financial Officer and General Counsel to report to the Board of Directors.

• CLINICAL EFFECTIVENESS:

1. Conduct risk analyses, for quality improvement.
2. Provide administrative oversight of the incident/event reporting system.
3. Collect, aggregate and analyze data from multiple sources to identify trends or patterns Review current literature regarding risk management issues, and bring issues to the attention of committees, departments, and administration as necessary to affect recommended changes in policies, processes and/or practice.
4. Facilitate and conduct investigations of identified patient events, unexpected outcomes, near misses and process variances.
1. Provide oversight and administrative management, in collaboration with General Counsel, to maintain attorney-client privilege and discovery protection throughout the course of the investigation and resolution; Develop and implement an investigation process in collaboration with clinical managers and others.
2. Collaborate with the Safety Officer to develop and implement a patient safety program; Collaborate with the Safety Officer to identify appropriate patient safety objectives; Report results of initial and intense investigations to the Event Oversight Committee; and Coordinate scheduling of the Investigative Core Team meetings.
3. Facilitate the intense investigation/root cause analysis process; Prepare intense investigation/root cause analysis reports to submit to the General Counsel or his/her designee, or outside Counsel and the Event Oversight Committee.
4. Submit intense investigation/root cause analysis team findings on quarterly Risk Management Reports to the Risk Management Committee of the Board, Quality Council(s).
5. Perform other pertinent duties as assigned by the General Counsel.

• RELATIONSHIPS:

1. Collaborate as appropriate, to facilitate disclosure of adverse outcomes as appropriate.
2. Assist and collaborate with patient/customer satisfaction activities to provide appropriate service recovery and complaint resolution; Develop and maintain professional contacts, communications and relationships.

• SAFETY:

1. Recommend and coordinate annual risk assessments for specific areas of service as identified through operational and process evaluations; Collaborate with administrative, clinical and operational leadership in the identification of processes and procedures appropriate for the implementation of Failure Mode Effect Analysis and implement improvement strategies. Guide the implementation of appropriate risk management interventions.
2. Report events and occurrences to appropriate regulatory agencies in collaboration with General Counsel.
3. Collaborate with clinical educators to implement System-Wide risk management, to establish a safe environment, and increase quality of service.

• PRIVACY OFFICER:

1. OVERSIGHT OF THE PRIVACY PROGRAM:
1. In collaboration with Health Information Management, the Chief Information Officer, the Executive Director of Human Resources and Information Services, develop, and maintain the Organization's protected health information privacy and security policies and report to appropriate governance committees, i.e., Corporate Compliance, and system leadership on the status of the privacy and data security risk activities.
2. Measure effectiveness, performance and quality of the program and report to the healthcare system leadership.
3. Collaborate and coordinate with the Chief Information Officer and the Executive Director of Human Resources to facilitate compliance audits and appropriate program monitors.
4. Assists the Executive Director of Human Resources to provide system privacy training when requested.
2. COMPLIANCE:
1. Establish, resolve, and administer a process for the investigation of and action taken on all complaints concerning the Organization's privacy and data security; Investigate and monitor all privacy complaints.
2. Review and confirm Organizational information, security and privacy management plans; Collaborate to ensure the availability of required documentation.
3. Direct and conduct compliance risk assessments; Ensure Organizational compliance with requirements regarding privacy and data security.
4. Ensure compliance with privacy practices and the consistent application of sanctions; Cooperate with the U.S. Department of Health and Human Service’s Office for Civil Rights, as appropriate.

• ADDITIONAL ESSENTIAL JOB DUTIES:

1. Provides reports to Leadership of the Organization on a routine basis.
2. Demonstrates a commitment to professional accountability and growth to maintain and expand knowledge and skills.
3. Contributes to the achievement of the mission, vision, and values of the Organization.
4. Contributes to the effective operations of the Organization by demonstrating dependability in job performance.
5. Demonstrates a commitment to incorporating the core concepts of patient family centered care into practice (dignity, respect, information sharing, and participation).
6. Demonstrates a commitment to the development and implementation of shared governance across the Organization.
7. Performs other related duties as assigned.

WORKING CONDITIONS, HAZARDS AND PHYSICAL EFFORT:

• Performance of this job generally does not involve exposure to blood, body fluids, tissue or general exposure to communicable diseases.
• Maintain the ability to navigate throughout the Organization including clinical and non-clinical sites and outside locations to respond to planned or unexpected situations which require scheduling adjustments and moderate amounts of travel.
• Work extended hours and maintain on-call availability to respond to emergency situations and events that require participation of Risk Management or the Privacy Officer.
• Function efficiently under moderate to significant levels of stress to meet reporting and regulatory requirements and deadlines.
• Endure exposure to significant levels of stress specific to communication with patients, patient families, physicians, the general public, community professionals, administrative leadership and clinical management staff while conducting investigations, mediating complaints and affecting conflict resolution.
• Maintain ability to independently move or position 25 lbs.

CONTACT WITH OTHERS:

Maintain routine communication with Senior Leadership, physicians, administrative staff, clinical and department directors, all Associates within the Organization, patients, patient’s families, professional and business contacts, as appropriate.

EQUIPMENT USED/SPECIAL SKILLS REQUIRED:

• Demonstrate computer skills and competency for use of Microsoft Word, Excel, Access, Publisher and PowerPoint, computer based reporting systems, Meditech, and other software as required.
• Demonstrate skills in the development and implementation performance improvement tools and techniques.
• Utilize interpersonal skills with a high degree of effectiveness in working with patients, families, professional, business and community partners.
• Demonstrate effective oral and written communication skills.