The Risk Manager is responsible for the review and evaluation of events entered into the Atlantic Health reporting system, and to identify potential claims, lawsuits, and reportability under the Patient Safety Act. Refers events to Peer Review, Quality & Outcomes Management and other committees to address as appropriate. Organizes and moderates Root Cause Analysis and assists with the development of corrective action plans. Coordinates and facilitates regulatory investigations and responds as needed. Management of the resolution process related to complaint/grievances. Provides education to nursing, medical residency staff and all ancillary departments as needed. Manages translation services
- Evaluates event for severity, frequency and probability of financial loss
- Reports as appropriate to administration and committees
- Responds to significant events; review facts; review medical record/documentation; preserve any evidence; conduct staff interviews
- Provides recommendations for staff re: investigation/handling of events to appropriate management, administrators
- Refers to Peer Review, Care Review, and Quality & Outcomes Management Committees to address as appropriate
- Develop educational programs as appropriate or needed based on event findings and trends
- Reviews events and identifies potential claims/lawsuits
- Prepares potential files, documenting factual investigation of event
- Communicates findings to the legal team as appropriate for case preparation
- Reviews incidents and determines reportability as a Serious Preventable Event under the Patient Safety Act
- Conducts initial team huddle and determines next steps along with Executive Sponsorship
- Submits initial notification of SPE to DHSS
- Organizes and moderates Root Cause Analysis meeting with health care providers involved to identify causal and contributing factors to the event, and assists with development of a corrective action plan
- Coordinates case presentations to Preventable Events Review Committee
- Advises site nursing staff, medical staff and administration on legal issues, billing, insurance, risk management, corporate compliance, EMTALA, HIPAA and other regulatory concerns following the review of regulations and standards.
- Addresses clinical queries by reviewing applicable policies and aligning responses with identified clinical needs
- Serves as a resource for all inquiries, fostering ongoing open communication and engagement
- Delivers targeted education and in service training to nursing , medical , and residency staff, as requested or informed by needs identified through case review and event reporting trends
- Topics include litigation process, documentation, event management, hospital policies, protocols
- Triages events, escalate, investigates and refers as appropriate, close events
- Acknowledges clinical staff for Good Catches
- Provide training to nursing staff, medical staff, and residency staff on use of program
- Coordinate and facilitate investigations (DHSS)(FDA) (CMS)
- Facilitate, prepare and submit material to agency and respond to deficiencies
- Coordinate voluntary and required reporting to the FDA
- Proactive management of difficult patients and family members of complex care cases to mitigate complaints
- Liaison between patient/family and nursing/physician teams to resolve concerns
- Manage the response process as well as the electronic documentation of all clinical complaints/grievances in the database
- Track and trend patterns of complaints/grievances and reports to leadership
- Ensure compliance with DOH/CMS regulations regarding clinical patient complaints/grievances
- Manage and arrange language translation services for patients and families while ensuring compliance with regulations
- Provide training to teams on language translation services as needed
