Job Summary:
Under the direction of the Regional Director, establishes, monitors and coordinates a comprehensive program of clinical and enterprise risk management functions that includes, but is not limited to risk identification, analysis, investigation, mitigation, prevention, control, education and consultation. Leads enterprise risk management activities and patient safety efforts at all acute and ambulatory care facilities for the Northwest region. Acts as a change agent to facilitate risk control and prevention through surveillance, education and participation in system/process re-design efforts.

Essential Responsibilities:

Provide basic and complex preventive risk management assessment of processes, procedures, and programs, including in-service education, consultation, liaison activities and on-call emergency assistance to clinicians, managers and staff members. Minimize clinical, operational, financial and strategic risks through rounding in assigned KPNW facilities at least annually. Responsible for the implementation of risk management activities on a day-to-day basis to further the organizations overall enterprise risk goals.

Collaborate with Quality, Patient Safety, Compliance and Operational departments to assist with Comprehensive System Analysis (CSA) for serious adverse and/or sentinel events and/or pro-active risk assessment. Participate in policy development and guidance to mitigate and prevent risks.

Conduct periodic trend analysis of data sources to identify and communicate themes and high-risk processes/ programs to key stakeholders and leadership teams as priority areas of focus. Act as a change agent to facilitate and influence risk reduction efforts with multidisciplinary improvement teams to develop system redesign in decreasing organizational risk. Monitor the progress and success of recommended actions and escalate challenges/barriers to senior leaders as appropriate.

Partner with Program Manager for Claims Resolution and support the Professional & Public Liability (PPL) team with investigatory activities of adverse events involving serious harm or death that include, but not limited to conducting chart review, writing clinical summaries, triaging, and prioritizing events for Risk Management physician review. Consult with Risk Management physician to determine liability assessment and Potentially Compensable Event (PCE) designation and/or referral for quality review. Identify events for potential early resolution and collaborates with the Health Care Mediator who initiates contact with patient and family utilizing appropriate communication skills.

Participate in the development and implementation of specific department goals and tactics consistent with the organizations strategic plan. Participate in improvement projects aligned with goals, tactics, and strategic plan. Ensure full and sustained implementation of process improvements. Other duties as assigned.

Serve on regional/national committees and task forces to address specific issues and/or represent the department as assigned.

Team with the Workplace Safety/Threat Management departments for Health Plan and Northwest Permanente Medical Group to address care plans for patients exhibiting unwanted or disruptive behaviors.

Review and respond to Risk Escalations from Member Relations, including allegations of negligence, quality of care concerns, and allegations of abuse.

Collaborate with Compliance and Quality & Patient Safety to investigate and respond to allegations of abuse, mistreatment, and discrimination.

Assist physicians, managers, and executive leaders to investigate and respond to threats of litigation, allegations of negligence, and quality of care concerns.

Basic Qualifications:
Experience

Minimum five (5) years of recent patient care experience in acute or ambulatory care setting.

Minimum two (2) years recent leadership, (e.g. Charge Nurse, Team Lead, Project Lead), supervisory or management experience in a clinical setting.

Education

Bachelors degree in nursing.

License, Certification, Registration

This job requires credentials from multiple states. Credentials from the primary work state are required before hire. Additional Credentials from the secondary work state(s) are required post hire.

Registered Nurse License (Washington) within 6 months of hire OR Compact License: Registered Nurse within 6 months of hire

Registered Nurse License (Oregon) within 6 months of hire

Additional Requirements:

Basic knowledge of TJC, CMS, OMPRO, HIPAA, employee relations, federal regulations, confidentiality issues and OR and WA state laws and statutes related to health care.

Basic knowledge of legal process and terms.

Working knowledge of quality management, utilization management, compliance, health care standards of care, laws and mandates.

Thorough knowledge and understanding of patient safety theory.

Strong customer-focused service, team building, problem-solving, critical thinking, coaching, presentation/teaching skills.

Excellent written and verbal communications, negotiation and human relation skills.

Proven ability to establish and maintain effective working relationships at various levels, both internally and externally.

Strong computer literacy in using various software systems.

Willing to successfully obtain certification in health care risk management (Certified Professional in Healthcare Risk Management) within three years of hire.

Preferred Qualifications:

Minimum three (3) years of recent risk management, quality management or loss prevention experience.

Masters degree in nursing, social work, health care administration or public health administration.

Basic understanding and experience with claims resolution process.

Strong project management skills or certification in Lean Sigma.

Familiarity with HMO organizational structure, managed care, and integrated systems.