Director, Risk and Claims

Director, Risk and Claims

Title: Director Risk and Claims

Location: Fountain Valley, CA

Department: Risk Management

Status: Full-time

Shift: Day

Pay Range*: $165,652- $227,832/annually

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary:

The Director of Risk Management plans, establishes and administers risk and claims management activities for the MemorialCare Medical Foundation (MCMF) risk and claims management programs designed to enhance the quality of patient care, improve patient safety, and prevent losses to the organization. Performs risk and legal analyses and provides clinical consultative services on risk prevention and mitigation strategies. Responsible for management and daily oversight of professional liability claims, procurement of insurance coverage and risk financing, interfacing with defense counsel to establish defense strategies, as well as communication to key stakeholders on claim status.

ESSENTIAL FUNCTIONS:

2. Responsible for management and daily oversight of all liability claims, NOIs, summons and complaints, and subpoenas. Retains, directs, and approves compensation of defense counsel, interfaces with defense counsel to establish defense strategies, and communicates to key stakeholders on claim status.

• Design and implement policies and procedures related to loss prevention, patient safety, risk mitigation, patient rights and/or physician responsibilities incorporating state and federal regulations, clinical best practice or other professional guidelines as applicable to the appropriate care setting.
• Conduct risk assessments and acts as a resource to administration, physicians, patients and employees relating to risk management services and clinical best practices for patient safety.
• Assist with redesign of clinical care processes in order to ensure patient safety and care processes are consistent with applicable legal, regulatory and licensing requirements.
• Conduct investigations of activities regarding actual or alleged liability (excluding Workers' Compensation) relative to patients, employees, physicians, and visitors. Analyzes potentially compensable events against standards of care and makes recommendations for actions
• Provide investigative and other support for event analysis (Root Cause Analysis, Intense Analysis, Failure Mode Effect Analysis) and designs and leads Lean and other process improvement activities.

• Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards

Minimum Requirements

Qualifications/Work Experience:

Minimum 5 years clinical risk management or medical malpractice legal experience

Strong leadership skills and ability to build consensus necessary

Flexibility, organizational awareness and strategic perspective required

Certification in Risk Management desirable

Possess strong oral and written communication skills

Demonstrate excellent time management, organizational and analytical skills

Employ diplomatic communication skills to effectively interact with staff, physicians, patients & families, as well as administration; to facilitate resolution of conflict and promote corrective actions

Education/Licensure/Certification:

RN licensure required

Juris Doctor or similar graduate law degree