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DIRECTOR, CLINICAL RISK MGMT DUHS

Job Title: DIRECTOR, CLINICAL RISK MGMT DUHS
Job Code: 5480
FLSA: E
Job Level: I2
Revised Date: 12/01/2018
Supervisory Responsibility: YES

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General Description of the Job Class

The Director, Clinical Risk Management positions provide oversight and support for specific divisions of the DUHS Clinical Risk Management department, assuring effective collaboration between departmental divisions and between the department and DUHS providers, employees, and departments. The Directors work closely with senior leadership and providers at the entity level. The Directors assist in coordinating and managing the business and operational aspects of the department as direct reports to the DUHS Assistant Vice President for Risk Management, and fulfills the duties of the AVP as delegated in an absence.

Duties and Responsibilities of this Level

Identify and analyze the potential impact of professional liability exposures for DUHS, including University level impact. Inform and provide guidance to entity leadership and providers on identification, evaluation, and management of professional liability and patient general liability exposures pertinent to operational issues and propose risk mitigation strategies, including financial factors.

Evaluate, manage, and provide recommendations for loss exposure mitigation to entity and clinical/support departments/programs/providers and medical staff committees based on DUHS loss patterns and state/national exposure trends.

Evaluate proposed clinical programs and process changes for risk exposures, considering the DUHS strategic plan in such evaluations. In close collaboration with entity leadership, proactively provide recommendations for effective linkage and design to mitigate risk in the operational setting.

Manage professional liability and patient general liability claims for DUHS providers, employees, and entities under DUHS insurance coverage, including supervision of front-line Risk Managers carrying out elements of the claim management process to assure compliance with insurance and regulatory requirements. Such claim management includes communication with claimants, notification to and investigation with providers and employees, review with expert witnesses as appropriate, development of a resolution plan, and finalization of disposition.

Take effective financial actions to respond to clinical risk management events and claims. Each Director maintains DUHS and PDC approved individual authority to commit to such patient/family assistance, patient billing charges, and event immediate support resources as is deemed necessary for effective management or resolution.

Respond on a timely basis to provider and administrator needs for assistance with urgent and emergent risk exposure/potential liability matters through direct interaction and through supervision of a 24 hour/7 day a week immediate access consultation availability.

Key role authority for immediate administrative decisions for response to urgent/emergent needs in critical event management. Such critical events include matters of high sensitivity, requiring senior level expertise and judgement.

Provide in-service education for clinical and support staff across DUHS on issues, exposures, and mitigation strategies in clinical risk, including as appropriate legal guidance as provided through Counsel's Office and regulatory and insurance requirements.

Assist Duke University departments/programs with clinical risk management issues involving DUHS entities, including DU Corporate Risk Management and Duke University Police.

Own relevant entity level policies, and provide guidance for the development and alignment of DUHS policies as appropriate to include risk mitigation strategies.

Compliance with federal, state, local, and agency regulatory requirements related to Risk Management, including the management of, investigation of, and response to events and grievances/claims.

Entity committee participation, support, and guidance providing linkage as appropriate for key issues under consideration by multiple committees/working groups. Directors may act in a designated staff role for entity medical staff or leadership committees.

Collaborate and coordinate with key leadership stakeholders in associated areas (e.g., Compliance, Patient Safety, etc.) to assure effective and aligned response to issues and events.

Lead and/or facilitate special projects as assigned by entity leadership.

- Supervision and direction of claims processes across DUHS, assuring compliance with regulatory and insurance requirements.

- Manage and develop educational resources, including in-service education, in response to staff needs and emerging professional trends and information, managing the department SharePoint site for consistent communication and reference materials.

- Provide periodic Risk Management reports to the Durham County Hospital Corporation Board through presentations at the Patient Safety and Clinical Quality Committee.

Required Qualifications at this Level

Education

Bachelor's degree in Business Administration, Healthcare Administration, or related field.

Experience

Minimum of 8 years progressively responsible experience in healthcare risk management, with at least 5 of the 8 years in a clinical risk management position with response to patient care events, complaints, and issues. Experience also is to include staffing and supervision of personnel.

Degrees, Licensure, and/or Certification

Certified Professional in Healthcare Risk Management (CPHRM) required.

Knowledge, Skills, and Abilities

Direct hands-on experience in response to patient care events, including entity-level critical events.

Direct hands-on experience with patient complaint, grievance, and claim management, response, and resolution.

Knowledge of and direct experience with risk management/claims management database systems

Knowledge of and direct experience with professional and patient general liability insurance programs.

Knowledge of financial systems involved with liability events

Proficient skills in public speaking/presentations

Distinguishing Characteristics of this Level

Critical thinking skills

Ability to quickly receive and integrate information in critical, time- sensitive matters

Ability to act decisively and appropriately in critical, time-sensitive matters

Very strong communication and team skills

Effective leadership skills in a complex environment


The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.


Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

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Essential Physical Job Functions

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.