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Compliance, Privacy & Regulatory

Putting Integrity Into Practice

Promoting honesty and integrity across our daily actions and interactions, our compliance, privacy, and regulatory professionals provide the guidance and resources to uphold the highest ethical standards.

Senior Risk Manager

Location: Rockville, MD Additional Locations:
Job Number: 857797 Date posted: 01/10/2020
Description:
Collaborates and develops a proactive risk management program to prevent or minimize losses in KPMAS Region. Manages, organizes, and assists with the implementation of the Regional Risk Management Program and related activities. Provides basic and complex preventive risk management assessment of processes, procedures, and programs, including education, consultation, and liaison activities. Initiates, coordinates, and manages all investigational and evaluation activities associated with professional and general liability occurrences. Identifies and manages actual or potential sources of financial loss arising from injury to the person, property, or reputation of KPMAS. Actively monitors Medical Device/Equipment Recalls and develops and coordinates response efforts. Functions as a key member of the Threat Management team. Acts to provide fair and equitable solutions to member disputes, suggesting dispute resolution processes for addressing and managing conflict, and determines appropriate reimbursements/payments under program guidelines. Serves to improve patient safety and enhance relations, build trust, and acts as a trusted information resource, facilitator, consultant and practitioner.

Essential Responsibilities:
  • Plans and organizes the development of effective methods for reporting of occurrences and near-misses by provider and staff through various sources, including medical records, outside medical settings such as hospitals,medical centers, security, quality management, etc.
  • Plans and organizes the development and maintenance of a risk management database to facilitate trending and preparation of risk management analyses identifying opportunities for improvement, improvement actions taken, and follow-up to evaluate compliance and efficacy.
  • Provide consultation, advice, resolution for medical/legal issues in a manner consistent with applicable KPMAS policies, State and Federal laws, regulations, patient rights and professional ethics. Provides risk management expertise to support the reduction of preventable errors in health care delivery.
  • Conducts thorough and timely PCE investigations. Collaborates with Director and other leaders to implement Early Resolution with members and/or their representatives as indicated. Collaborates with Regional Claims Manager for successful management and disposition of pre-suit claims. Serves as a departmental resource for these processes.
  • Investigates and analyzes actual and potential risks on a proactive and preventive basis; develops and maintains a mechanism to receive and disseminate safety alerts; and works with biomedical engineering to investigate reports of product and equipment problems to determine appropriate response and coordination of medical device tracking and reporting efforts.
  • Coordinates Significant Event reporting. Works with departments to complete root cause analysis and implement corrective actions when needed. Collaborates with physicians and departments to develop strategies when communicating with members after adverse events.
  • Assesses the need for risk management related education and coordinates the development, completion and evaluation of these programs with the appropriate departments such as new employee orientation, infection control, etc.
  • Monitors new practices to identify additional risk and assist departments in minimizing and avoiding liability.
  • Develops educational and training programs for providers and staff regarding risk trends and avoidance. Develops methods to monitor the impact of this training.
  • Develops structures to keep the organization in compliance with accreditation standards, federal and state laws and regulations, and KP's internal requirements related to risk management. Communicates findings and risk prevention strategies to regional providers and staff.
  • Assists other KP departments in complying with accreditation and regulatory risk management standards,i.e.policies and procedures, legal claims manager, etc.
  • Coordinates the implementation of rapid response mechanisms and situation management procedures for onsite patient and/or member issues.
  • Partners with other departments such as Quality Management, Patient Safety, Operations, Customer Service Call Center, Member Services, EH&S, and Security in the identification and response to risk threats.
  • As part of the Threat Management Team, responsible for receiving, validating, interpreting, responding to, and managing threats. Develop intervention plans that protects KP and its members and addresses and mitigates conflicts that precipitated the threat. Document the threat assessment process allowing for confidentiality in accordance with privacy requirements and other KP policies. Conduct an after-action review/debrief process.
  • Develops and maintains a mechanism to receive and disseminate safety alerts, medical device/equipment recalls, and coordinate appropriate tracking, response, and reporting efforts.
  • Requires Risk Manager on-call duties
  • Other Duties as assigned
  • Basic Qualifications:
    Experience
  • Minimum five (5) years of direct experience in the direction, management and analysis of patient safety/risk management data, quality, and patient safety in health care/managed care fields required.
  • Minimum five (5) years of clinical healthcare experience
  • Minimum three (3) years of experience with federal and state laws and regulations
  • Minimum three (3) years of experience with early resolution, mediation, or dispute resolution
  • Education
  • Bachelor's degree in nursing or other health related field required.
  • License, Certification, Registration
  • RN license in Virginia, District of Columbia, and Maryland
  • Current CPHRM designation or must achieve within six (6) months.

  • Additional Requirements:
  • Proficient in computer applications including Microsoft Office Suite required.
  • Strong interpersonal skills, with good verbal and written communication skills required.
  • Skills in problem-solving and collaboration with other professions/ disciplines required.
  • Skill and experience in organizational change management required.
  • Demonstrated leadership skills required.
  • Knowledge of legal issues and State and Federal Laws
  • Knowledge of compliance and accreditation standards
  • Data management and interpretation, effective communication skills
  • Strong assessment and analytical skills necessary.

  • Preferred Qualifications:
  • Knowledge of Kaiser Permanente preferred.
  • Advanced Proficiency with MIDAS+ reporting system preferred.
  • Early Resolution, mediation, or Ombudsman experience preferred.
  • Experience with Threat Management or patient/customer negotiation strategies preferred.
  • Completed coursework in Early Resolution or Mediation preferred.
  • Master's degree in related field preferred.
  • Primary Location: Maryland,Rockville,Rockville Regional Offices 2101 E. Jefferson St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon - Fri Working Hours Start: 8:00 AM Working Hours End: 4:30 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Individual Contributor Job Category: Compliance / Privacy / Regulatory Department: Risk Management Travel: Yes, 50 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

    About Compliance, Privacy & Regulatory Careers

    Compliance, Privacy & Regulatory Careers

    We've established a comprehensive, world-class compliance, privacy, and regulatory program, giving you the chance to make a difference in the lives of millions. As a member of this team, you'll engage with internal stakeholders to foster an environment of safety and trust for our members, physicians, and employees alike.

    Helping to establish and maintain an effective compliance program, you'll ensure that we operate according to the highest ethical standards and follow all applicable laws, standards, policies, and procedures. Everything we do — from developing policies and training to protecting privacy and security — reinforces our commitment to our members, regulators, and the communities we serve.

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