Director of Risk Management/Performance Improvement Quail Run Behavior - Phoenix, Arizona, United States, 85027

One of the nation?s largest and most respected hospital companies, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Steadily growing from a startup to an esteemed Fortune 500 corporation, UHS today has annual revenue nearing $10 billion. In 2017, UHS was recognized as one of the World?s Most Admired Companies by Fortune; ranked #276 on the Fortune 500, and listed #275 in Forbes inaugural ranking of America?s Top 500 Public Companies.
Our operating philosophy is as effective today as it was 40 years ago: Build or acquire high quality hospitals in rapidly growing markets, invest in the people and equipment needed to allow each facility to thrive, and become the leading healthcare provider in each community we serve.
Headquartered in King of Prussia, PA, UHS has more than 81,000 employees and through its subsidiaries operates more than 320 acute care hospitals, behavioral health facilities and ambulatory centers in the United States, Puerto Rico, the U.S. Virgin Islands and the United Kingdom.

Quail Run Behavioral Health is seeking a dynamic and talented Director of Risk Management and Performance Improvement

The Director of Risk Management and Performance Improvement (RM/PI) has broad responsibility to protect the hospital's assets from loss. The Director of Risk Management/Performance Improvement is responsible for coordinating the loss control efforts and advising management and administration on all potential sources of loss and for making recommendations to minimize or eliminate exposure. The structure and functions of the Risk Management Program are designed so as to comply with guidelines and standards of TJC, other regulatory agencies, and the UHS . ? Program.

Key Responsibilities include:
Risk identification and Evaluation
  1. Ensures appropriate and timely reporting of occurrences by maintaining a Healthcare Peer Review Reporting system (Occurrence notification system); enters incidents into the MIDAS Database.
  2. Collects and screens all reports.
  3. Analyzes and trends data
  4. Identifies actual and potential risk situations and facilitates the determination of causative factors
  5. Refers occurrences for follow-up to appropriate department or medical committee; ensures that all Level III/IV are referred to the Peer Review Committee
  6. Receives immediate and concurrent reporting of adverse patient outcomes identified by the PI process
  7. Performs risk surveys and inspects patient care areas in concert with hospital's safety (EOC) program committee objectives
  8. Reviews reports on facility and equipment to assess loss potential
  9. Receives and investigates reports of product problem to determine appropriate response and establish record keeping responsibilities. In the event of patient injury, established direction from Corporate Risk Management in the appropriate action for defense strategy
  10. Receives information (verbally or formally on the HPR) from facility staff regarding patient events which may lead to a claim.

Risk Reduction
  1. Networks with department managers to implement system changes aimed at optimally reducing or eliminating causative factors.
  2. Interfaces with Performance Improvement Director specific to provision of patient care, and assessment of quality data
  3. Networks with medical staff to ensure active involvement and participation in:
    1. Risk identification
    2. Risk analysis
    3. Risk reduction/loss prevention problem solving and program development designed to benefit the clinical aspects of patient care and safety
  4. Networks with medical staff to ensure the credentialing and privilege delineating process requires information regarding professional liability experience, results of peer review activities, changes in medical staff memberships, clinical privileges, licensure, etc.
  5. Interfaces with the Patient Advocate specific to patient complaints and assesses/recommends action, on those, which may be a source of potential litigation.
  6. In conjunction with hospital administration recommends actions when possible to resolve with patient and/or family any grievances against hospital perceived as potential liability claims.
  7. Refers policies that present particular risk in relation to previously identified problems to Corporate Risk Management
  8. Identifies particular practices having legal connotations to target planning of preventive and corrective measures
  9. Assesses liability and probability of legal action
  10. Is available to resolve treatment issues, including patient refusal of treatment, consent issues, HIPPA violations, AMA's, etc. under direct supervision of Administrator, Corporate Legal Counsel, and Corporate Risk Management

Contract preparation
  1. Assists Administration in preparing contracts for approval
  2. With assistance from Corporate Risk Management provides advice on contract language necessary to fulfill insurance and Risk Management requirements
  3. Evaluates each contract negotiated by the hospital with assistance from Corporate Risk Management when needed to ensure that insurance and liability losses are adequately addressed and that risk is transferred to other party responsible

Claims Management
  1. Assists Administrator in facilitating the processing of summons and complaints served on the hospital and its employees.
  2. Reports receipt of summons and complaints immediately to Corporate Risk Management and Insurance Department.
  3. Assists the Corporate Risk Management as needed to intervene, document and assist in the investigation of all claims.
  4. Coordinates investigation of claims within the facility:
    1. Directs in-house claims investigation.
    2. Preserves all pertinent information (medical record, x-rays, equipment, lab/pathology specimens, relevant reports/d policies and procedures)
    3. Facilitates early reporting
    4. Establishes early control of situation
    5. Assists in obtaining materials for attorneys
    6. Maintains all legal case files and ensures maximum protection and discoverability
  5. Coordinates with and assists attorneys as they interface with the facility and employees.
  6. Advises Business Office of actions consistent with directions from Corporate Office for unpaid accounts involved in litigation.

Loss Control and Prevention
  1. Conducts/facilitates in-services to educate employees and physicians
  2. Participates in developing/reviewing policies and procedures
  3. Operates to maintain and facilitate system securing hospital, employee and patient property.

Committee Participation
  1. Performance Improvement
  2. Patient Safety Council
  3. Peer Review
  4. Environment of Care/Safety
  5. Production evaluation
  6. Medical Records/ Utilization Review
  7. Pharmacy & Therapeutics
  8. Infection Control
  9. Other Committees/Meetings as necessary

Employee/Physician Education
  1. Facilitates, develops, and provides educational programs to insure all employees and medical staff are aware of the Risk Management concept and its relation to their specific duties/job role in identifying and reducing liability exposures.
  2. Plans and presents risk management1 information to all new employees at hospital orientation.
  3. Plans and presents Risk Management information to all employees at annual update.
  4. Plans, presents, facilitates, and/or recommends in-services to all departments as necessary to address Risk Management problems
  5. Submits articles to hospital, nursing, medical staff newsletters, as appropriate
  6. Plans and presents in-services/information at Department Managers meetings. Provides Risk Manager presentation specific to management levels at least annually
  7. Shares current literature and articles of relevance with all appropriate departments
  8. Plans, facilitates, presents information and suggests topics on Risk Management to Committees or hospital departments as necessary and based upon occurrences or claim patterns.

Reporting, Report Preparation and Submission
  1. Provides aggregate analysis of risk data and trend analysis of incidents to:
    1. Corporate Risk Management
    2. Patient Safety Council
    3. Performance Improvement
    4. Environment of Care/Safety Committee (Safety related only)
    5. Governing Board
    6. Medical Staff Committees/Department as necessary and related to the department
  2. Incidents with Claims Potential
    1. Directly reports to Administration those incidents with claims potential.
    2. Reports to Corporate RM any serious risk event involving actual or potential injury to patients and visitors; enters PCR?s (Level III/IV incidents) into STARS Database within 10 business days of the incident.

Medical Staff
  1. Advises the Medical Director and Medical Executive Committee as needed
  2. Serves as a resource to the Medical Staff Credentialing Process and the Credentials Committee as needed. Data from physician peer review and risk management activities are utilized in the decision making process of granting privileges to and reappointment of medical and allied health staff.
  3. Develops, coordinates, presents/facilitates educational programs specific to medical staff concerns.
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