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Director of Patient Claims
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Director of Patient Claims
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Director of Patient Claims
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Director of Patient Claims - Washington, United States - MedStar Health
Description
General Summary of Position Reporting to the Assistant Vice President of Quality and High Reliability with matrix reporting to the Vice President for Risk Management Services for MSH., the Director of Risk and Claims Management directs, designs, implements and maintains the Risk Management Program in order to reduce incidence and magnitude of loss to the Hospital.
Responsible for fully supporting MedStar's captive insurance program, Greenspring Financial Insurance Limited (GFIL), as well as MedStar's early intervention, patient safety and loss prevention programs.
Protects the Hospital's assets through risk and claims management and loss control and a focus on patient safety.These functions are performed in accordance with all applicable laws and regulations and MWHC's and MedStar Health's philosophy, policies, procedures and standards.
Primary Duties and Responsibilities Develops, and upon approval, implements and administers hospital internal risk management and patient safety programs in accordance with all federal, state and regulatory agency requirements.
Participates in and directs the investigation, documentation and assessment of all actual and potential liability risk exposures (which include Patient Safety Events (PSEs)) for the hospital.
Designs and implements programs and strategies to minimize or eliminate risk exposures.Analyzes data and reports to hospital administration and our Risk Management Department on a regular basis regarding Risk Management program, trends, and current issues.
Develops, presents and evaluates educational programs relating to risk management theory, current issues, regulations and incident prevention.Selects, trains, and orients personnel who will include risk management consultants and a risk management data analyst.
Monitors and supervises risk management and claims work, evaluates performance, and initiates or recommends personnel action such as merit increase, promotions, and disciplinary actions.
Maintains ongoing communication with associates to review programs, provide feedback, discuss new developments, and exchange information.Actively participates in the medical professional and general liability claims management program for the hospital and under the direction of the MedStar Health Risk Management Department.
With guidance of MSH VP, Risk Management, oversees the handling of claims at MWHC including reserves, communication with patients and or families, documentation, evaluation, and patient bill holds.
Works with hospital leadership regarding decisions to waive bills in connection with a risk event or an adverse event.Works closely with the MedStar VP, Risk Management to manage financial aspects of the MedStar's medical professional liability and corporate general liability claims program including establishing and maintaining a sound claims-reserving program that ensures that liability exposure is timely and adequately recognized and recorded.
Develops and maintains ongoing positive relationships with insurers, attorneys, mediators, legislators, and other constituents; takes a leadership role in broader tort reform efforts both locally and nationally.
Responsible for developing and maintaining a strong positive working relationship with MWHC, including hospital president, MWHC senior vice president of Medical Affairs regarding all aspects of claims and litigation management, keeping them fully informed regarding the status of claims or suits.
Routinely provides presentations to the Chief Medical officer, Chief Nursing Officer, Chief Operating Officer and Chief Quality Officer on significant cases.
Conducts training for residents, physicians, nurses and other clinical staff regarding risk management strategies, appropriate documentation in medical records, disclosure conversations with family members and other risk and claims management topics.
Minimum QualificationsEducation Jurisprudence doctorate required
Bachelor's degree in Nursing preferred
Experience 5-7 years required
Licenses and Certifications Licensed Attorney (varies by state) required
RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred
Knowledge, Skills, and Abilities Excellent oral and written communication skills, including presentation presence. Demonstrates strong organizational prioritization and delegation skills while working with minimal supervision. Ability to form strong working relationships with both clinical and administrative leadership.
The ability, interpersonal skill and empathetic demeanor to be able to successfully connect with patients and their families and MedStar staff, including nurses and physicians, at times of high stress.
Ability to identify, analyze and evaluate complex clinical and legal problems and recommend solutions. Able to make independent and timely decisions involving complex situations. Possesses the ability to work as an effective member, at times the leaders, of multiple teams.Solid judgment, conceptual and anticipatory skill s with a proven ability to think creatively and be flexible in order to meet all challenges.
Proven high level of integrity and personal ethics.Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered.
We live up to this promise through:
Strong emphasis on teamwork- our associates feel connected to each other and our mission as an organization.
In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
Strategic focus on equity, inclusion, & diversity- we are committed to equity for all people and communities.We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
Comprehensive total rewards package- including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
More career opportunities closer to home- as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research.
Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation.
As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team.
Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities.
It's how we treat people.MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees.
We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations.
MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws.
If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.
