Clinical Risk Manager

Job Description Summary

Under the leadership of the Executive Director of Risk Management, the Clinical Risk Manager contributes to the day-to-day operations, management and advancement of South Shore Health’s Risk Management Program. This includes participating in proactive, system-wide risk identification, investigation, mitigation and risk reduction activities. The South Shore Health (SSH) Clinical Risk Manager serves as a subject matter expert providing risk management consultation and support to providers and staff as needed. Under the direction of the Executive Director, the Clinical Risk Manager submits reports to external agencies ensuring compliance with regulatory requirements.

Job Description

Job Responsibilities:

• Participates in planning, implementing, managing, monitoring, and documenting an integrated, comprehensive and proactive risk management program for SSH.

• Collaborates with Patient Safety, Regulatory/Accreditation, Compliance, Quality Management, and departmental quality leaders to identify and assess unusual incidents, unexpected outcomes, and potential risks, translating learnings into the development of loss prevention strategies. 

• Performs comprehensive system analysis of patient safety events utilizing just culture principles and standard processes.  Focuses on high reliability concepts when developing improvement initiatives.

• Identifies organizational risk through trend analysis of incidents, safety events and key performance indicators.

• Performs root cause analysis on all serious reportable events (SREs) and other events as appropriate. Supports staff in investigation/review process, debriefs, corrective actions and follow-up.  Completes required reporting and documentation in accordance with legal, regulatory, accreditation standards and requirements.

• Participates in on-call schedule to enable 24/7 coverage for inquiries on risk management matters.

• Ensures appropriate and timely communications with health system and departmental leadership concerning professional liability matters.

• Assists with supporting and coordinating Medical Staff Peer Review Committees, working closely with Medical Staff leadership, providing accurate clinical summaries, data trending, reports and analysis.

• Manages risk management information system database. Identifies organizational risk through trend analysis of case reviews.

• Collaborates with the Office of Patient Experience, reviews patient complaints that may result in legal action. Works with patient advocacy to resolve patient grievances.

• Partners with Risk/Safety team members to coordinate and facilitate risk and safety education.

• Maintains current and accurate knowledge of regulations, laws and standards pertaining to SSH, including but not limited to FDA, TJC, DPH, and CMS Medicare Conditions of Participation.

• Serves as internal consultant to hospital departments and leaders on matters of regulatory compliance, medical malpractice and other health care related rules/regulations/laws. Appropriately involves SSH Office of the General Counsel when appropriate.

• As requested, serves as institutional liaison to professional/general liability insurers.

• Integrates risk management program activities with clinical programs, hospital and health system operations and administration, such as patient safety, regulatory/accreditation compliance, patient care services, environmental safety, human resources, infection control, occupational health, clinical laboratories, physician services, information management, compliance/privacy, etc.

• Works with medical staff, clinical services, patient safety, quality management and administration to develop clinical and systems approaches to error prevention.

• In collaboration with Health Information Management and the Privacy Office, advises and assists with the operational implementation of HIPAA privacy regulations.

• Day-to-day direction and coordination of the Risk Management Department including but not limited to:

  • Supporting hospital and medical staff regarding legal, risk and ethical issues.

  • Participating in investigations related to adverse events for evaluation of clinical improvement and regulatory reporting.

  • Provides advice and direction to the Patient Experience Office on legal, risk, and patient safety issues.

  • Responsible for intake of adverse hospital and patient events that may result in a potential or actual claim:

• Reviews adverse event reports to ensure timely and appropriate analysis and follow up

• Evaluates and manages reporting of adverse events and potential claims to insurers

• Participates in review and development of relevant institutional policies

• Participates in hospital patient safety initiatives and process improvement activities

• Participates on the Quality Council, Patient Safety Committee, Joint Commission Core Team, and Environment of Care Committee, and other Committees, as need is identified.

• Data Analysis:

  • Performs data analysis of safety event reporting relative to adverse incidents to identify trends, and signals of risk

  • Collaborates with hospital administration and departmental quality groups to design programs to prevent medical error and reduce loss

  • Reviews and evaluates aggregate adverse events and claims data, as well as other hospital information in order to identify high-risk activities, procedures and departments

  • Reviews and evaluates results of regulatory/accreditation surveys and mock surveys to ensure policies and procedures support safe, compliant practice

  • Recommends corrective and preventive actions to reduce risk. Collaborates with insurer and hospital-based improvement teams on interventions

• Under the direction of the Executive Director of Risk and the Office of Legal Counsel, assists in the claims management process for the hospital including directing management of legal claims involving hospital and staff and collaborates with insurers, as needed.

• Development of institutional communication and education strategies related to Risk Management, quality and patient safety issues and compliance with emerging regulatory, case and statutory law.

Job Requirements:

Minimum Education - Preferred

Bachelor of Science in Nursing or other health related science from an accredited school, Masters preferred

Minimum Work Experience

3+ years Hospital or Health System Risk Management experience

Required Licenses

Current MA RN licensure

Required Certifications

CPHRM or CPPS preferred. Required within one year of hire.

Required Skills, Knowledge, and Abilities:

• Strong interpersonal and leadership skills to lead and direct system-level IPC program.

• Ability to collaborate and partner across all levels and functions within the organization.

• Possesses strong analytical skills to identify and monitor practice patterns and trends and identify opportunities for improvement.

• Requires strong organizational skills to manage many competing timetables and responsibilities. The ability to delegate, effectively supervise and plan for the timely and successful completion of short and long-term objectives is essential. The responsibilities of this position require detailed, concentrated effort and constant re-establishment of priorities as well as complex and sensitive decision-making.

• Possesses strong communication skills to serve as liaison to internal and external stakeholders. Requires superior skills in financial, written, and oral formats.

• Ability to interact with all members of the organization in ways that enhance understanding, respect, collaboration and problem solving.

Leadership Competencies:

• Passion for and commitment to the organizational mission and serving as a key member of the organizations leadership team.

• Sets an honest, transparent and positive tone in all areas and works in concert with leadership, medical staff and other members of care delivery to establish a collaborative environment.

• Strong communication skills in all venues; strong focus on listening to understand.

• Solutions-oriented coupled with the ability to function well in a culture that values relationships and collaborative decision-making.

• Ability to serve as a role model in commitment, engagement, and accountability for the provision of outstanding patient care.

• Ability to mobilize teams for common goals and shared vision.

• Positive change agent who builds a solid infrastructure and organizational foundation.

• Value driven commitment to the provision of quality, safety and patient/family centric healthcare services.

• Ability to proactively identify problems, lead change, and overcome obstacles.

• Data driven, results-oriented style with a high degree of analytical ability and proven problem-solving skills.

• A team player who can build collaborative relationships across the organization.

• Able to proactively cultivate new and innovative approaches and solutions to infection prevention and control issues that promote the mission, vision, values, and culture of South Shore Health.