Director Risk Management amp Insurance Services

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Director, Risk Management & Insurance Services
Duties: Reporting directly to the Vice President Legal Services, responsible for providing system-wide leadership for the organization’s risk management program and for managing internal processes to support the organization’s self-insured programs. Works collaboratively with the VP of Legal Services to develop, and ensure the effectiveness of, systems to identify, evaluate, and mitigate risk for the organization on an ongoing basis, ensuring that risk mitigation strategies cover both hospital-based and ambulatory services, including employed physician practices. Ensures that the organization’s risk management policies, procedures and practices are in compliance with all applicable laws and regulations. Provides oversight for the management of insured claims and all claims management processes that support the organization’s self-insured programs; effectively utilizes both internal and external claims management resources. In collaboration with VP Legal Services and the Chief Financial Officer, responsible for managing system-wide commercial insurance programs and for continuously evaluating the organization’s portfolio for coverage gaps and mitigation strategies. Plans, leads and evaluates the organization’s system-wide risk management program. Ensures effectiveness of program to reasonably detect, prevent and mitigate organizational risk. Develops and implements systems to complete organization-wide risk assessments on an ongoing and systematic basis. Ensures that appropriate action plans and mitigation strategies are developed in response to assessment findings. Works collaboratively with management, physicians and staff in both assessing and mitigating risk. Develops, provides and/or coordinates system-wide risk management educational programs. Serves as internal resource for risk-related patient care questions and/or issues (e.g., consent, guardianship, patient capacity, disclosure of adverse events). Ensures an effective process for identifying, reporting and managing incidents, claims, potentially compensation events and/or law suits. Provides for effective coordination with third party claims administrators, as well as internal and external counsel. In collaboration with CFO, VP Legal Services and external broker, continually evaluates the organization’s insurance portfolio. Oversees process for completion of all commercial insurance applications.

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