Risk Management Specialist "Job Details"
Winston-Salem, NC, United States
- Medical Center Blvd, Winston Salem, NC, 27157, US
10/01/2021, 04:15 PM
JOB SUMMARY: The Medical Center Risk Management Specialist (RMS) position is responsible for independently investigating all professional liability occurrences and evaluating the available information to identify standard of care issues, opportunities for quality improvement, and preparing for the legal defense of potentially compensable events. The position also investigates property loss, general liability, and premise liability events. With each of these roles, responsibilities include review and analysis of medical records; equipment investigation to secure evidence and maintain chain of custody; identification of witnesses, experts, and staff with knowledge and information appropriate for claim consideration; ability to identify and act in risk situations; expertise and independent judgment in Medical Center processes and policy to proactively analyze a situation while in the middle of an interview to efficiently and completely gather the key event details; claim data system and specialized legal analysis with authority to act through consultation with Director when applicable. The RMS works directly with the Case Managers and Third Party Administrator to provide vital information on professional and general liability claims. Key skills required are ability to think and analyze in the middle of a discussion; knowledge of medical procedures and equipment; awareness and application of appropriate medical processes for each department and role in all areas of the Medical Center; ability to take charge in risk situations to protect the interests of physicians, staff, guests and Medical Center; knowledge of North Carolina law and ability to apply that knowledge during scene investigations; and specialized knowledge of construction and building requirements to apply and resolve property loss claims. The RMS must always exhibit a professional demeanor and conduct ethical, confidential and accurate investigations. Personal interaction with employees, medical providers, patients, guest, legal advisors and students is a daily requirement and plays a crucial role in claim processing and resolution. Responsibilities require specialized knowledge of NC law combined with annual training of applicable laws and regulations. The RMS will ensure confidentiality of all information concerning patients and visitors. EDUCATION/EXPERIENCE: Graduation from an accredited school of nursing, BSN preferred. Minimum of 3 years clinical experience required. Prefer knowledge of liability insurance policies and coverage, as well as familiarity with medical terminology and medical environment. REPORTS TO: Director of Risk Management LICENSURE, CERTIFICATION, and/or REGISTRATION: Active NC RN license required. Must have or obtain North Carolina Adjusters License within the first year of employment. Recommend Associate in Risk Management Certification (ARM) or Legal Nurse Consultant Certified (LNCC). ESSENTIAL FUNCTIONS: 1. Ensures education and compliance with general hospital standards and risk prevention during investigations to maintained and promote a cooperative work environment. Must have full understanding of the policies and enforces these by utilizing communication skills interpersonal relationships and team building. Must follow Medical Center policies and procedures; contribute to the overall quality of services; assume responsibility for keeping informed about changes in policies and procedures and maintain current knowledge of applicable investigative techniques laws, regulations, and statutes that affect the Medical Center. 2. Conducts prompt, thorough and concise investigations to avoid civil liability involving professional liability, medical malpractice, property loss, general liability, and premise liability. Responsible for contacting Medical Center personnel, visitors, witnesses claimants and involved parties to determine facts of the event; conducts formal and informal interviews; dispatched to event locations for immediate event assistance; responds to Code 44 events, preserves event details for future litigation potential, and diagrams case chronologies to formulate comprehensive investigations with due diligence. The RMS works on major cases to determine the appropriate conclusions. Must work closely with medical staff from physician to maintenance worker to gather and consider appropriate facts and details for complete investigations and thus adjusts claims within the guidelines of the North Carolina Fair Claims Handling Act and departmental protocols. Investigations include focus on sentinel events, drug thefts/diversions, and major case due to the number of impacted people, the amount of property involved, the seriousness of the injury, or the time required to complete. With completion of investigations reporting is then made to Case Managers, Risk Management leadership, Patient Relations and Patient Safety to enable claim resolution. 3. Requires knowledge of a variety of areas which include medical care, medical equipment, North Carolina law, fair claims practices and regulatory reporting requirements for healthcare industry to enable effective processing. 4. Investigates reports of patient injuries related to medical device failures and/or malfunctions and reports findings to Case Manager. Works efficiently to complete equipment investigation to secure evidence or return equipment back to service. Understands and follows North Carolina procedure in establishing the chain of evidence in investigations. 5. Liaison for Department of Social Services and law enforcement in addressing questions and information on events regarding patient status, production of evidence, patient/staff threats or violence events. 6. Serves as a consultant to Medical Center staff and faculty on risk management issues in order to minimize risk exposures. Provides consultation using risk prevention techniques. 7. Responsible for bringing appropriate Medical Center experts, department personnel and leadership to address and reach resolution or decisions for appropriate patient care. 8. Reviews RL incident reports to evaluate injury severity and to initiate active investigations. Assists in identifying reports appropriate for Patient Occurrence Root Cause Analysis Activity Report. With Risk Management and Patient Safety, follows up on action plan for prevention of re-occurrence of the problem. Notifies appropriate parties of the incident and severity. Reviews all events reported in RL6 for accurate coding and further action needed. 9. Assists in eliminating hazards and maintaining a safe environment. Identifies hazards from the review of visitor, patient and employee incident records; notifies the appropriate department to take action to eliminate the particular hazard; and conducts follow-up to verify the hazard has been eliminated. 10. Responsible for Patient Relations investigations and complaint handling which includes confirmation of care details, participation in claim reviews, and securing of financial information to enable recommendations for billing adjustments where appropriate. SKILLS/QUALIFICATIONS: Excellent oral and written communication skills Strong interpersonal skills Must have or obtain North Carolina Adjusters License within the first year of employment. Recommend Associate in Risk Management Certification (ARM) or Legal Nurse Consultant Certified (LNCC). Ability to conduct interviews and gather facts without prejudice. Successfully lead the interview process in order to gain the pertinent information necessary to properly evaluate a claim. Must be able to accurately document important details throughout an investigation and be able to organize the work product in a clear and concise manner. Show creative thinking to develop and refine processes to more effectively serve our customers. Demonstrate a willingness to learn and be open minded to new ideas and concepts. Effectively manage a busy workload, handle phone calls and e-mails in a timely manner and efficiently prioritize task. Proficiency in Microsoft office applications Knowledge of medical terminology WORK ENVIRONMENT: Clean, well-lit, comfortable office setting Most work task is performed in an office setting. Investigations may require the claims manager to report to the scene of an incident to gather important information about the event; must be able to tolerate a variety of outside and indoor environments. Local travel to Davie Medical Center, Lexington Medical Center and other subsidiaries is required on an occasional basis. Out of town travel is limited to 2-3 trips per year. PHYSICAL REQUIREMENTS: 0% 35% 65% to to to 35% 65% 100% N/A Activity X Standing X Walking X Sitting X Bending X Reaching with arms X Finger and hand dexterity X Talking X Hearing X Seeing X Lifting, carrying, pushing and or pulling: X 20 lbs. maximum X 50 lbs. maximum X 100 lbs. maximum
Wake Forest Baptist Health and Atrium Health have joined forces in a strategic combination that will enhance care, transform medical education and create economic opportunity for countless lives in North Carolina and beyond. As a part of that combination, the two health systems will be integrating technology and platforms, including our career sites.
This means that although you are applying on the Wake Forest Baptist Health Career Site, you receive communications from the Atrium Health Recruitment Team. Please know that this is an expected process, and thanks in advance for your flexibility.
Wake Forest Baptist Health (www.WakeHealth.edu) is a nationally recognized academic health system in Winston-Salem, North Carolina, with an integrated enterprise including educational and research facilities, hospitals, clinics, diagnostic centers, and other primary and specialty care facilities serving 24 counties in northwest North Carolina and southwest Virginia.
It comprises: a regional clinical system with more than 300 locations, 2,100 physicians and 1,535 acute care beds; Wake Forest School of Medicine; and Wake Forest Innovations, which promotes the commercialization of research discoveries and operates Innovation Quarter, an urban research and business park specializing in biotechnology, materials science and information technology. Wake Forest Baptist’s clinical, research and educational programs are consistently ranked among the best in the country.
About the Team
Wake Forest Baptist Health's mission is to improve the health of our region, state and nation by:
- Generating and translating knowledge to prevent, diagnose and treat disease.
- Training leaders in health care and biomedical science.
- Serving as the premier health system in our region, with specific centers of excellence recognized as national and international care destination.
Wake Forest Baptist Health is a preeminent learning health system that promotes better health for all through collaboration, excellence and innovation.
- Demonstrate the highest standards of patient-centered care, education, research and operational effectiveness
- Responsive to the physical, emotional, spiritual and intellectual needs of all
- Cultivate selfless contribution for the greater good
- Demonstrate fairness, honesty, sincerity and accountability
- Demonstrate respect for and inclusion of all backgrounds, identities, experiences, and perspectives
- Foster mutual respect, facilitate professional growth and mentorship, and reward teamwork and collaboration
- Promote creativity to enhance discovery and the application of knowledge
- Embrace a culture of reliability through better process design and accountability
Patient and Family Promise
We promise to:
- Keep you safe.
- Care for you.
- Involve you and your family.
- Respect you and your time.