JOB TITLE: Manager, Risk Management DEPARTMENT: Legal and Risk Management REPORTS TO: Director, Risk Management FLSA Status: Exempt Pay Grade: 127 Position Summary Covenant Health is seeking a Risk Management Manager to lead risk management functions at St. Joseph Healthcare in Bangor and St. Mary’s Hospital in Lewiston. This role focuses on identifying and assessing risk exposure, implementing loss prevention strategies, and maintaining a safe environment for patients, families, and employees. The Risk Management Manager also works to mitigate legal exposure, assist in legal claim defense, and oversee designated aspects of the organization’s insurance portfolio. While this position offers the potential for hybrid work, candidates must be based in the Bangor, Maine area. Job Responsibilities: + Participates as a member of appropriate committees and task forces assigned to improve quality, safety and to reduce organizational risk. + Develops statistical and qualitative reports on risk management trends and patterns and communicates this information effectively to appropriate audiences within the Health System + Ascertains that risks are minimized through follow up and actions on all regulatory/insurance survey report recommendations/deficiencies. Is aware of the fiduciary duties to identify, disclose and manage the organization’s risk. Adverse Events/ Claims – 20% + Evaluates all incidents for severity, frequency, and probability of financial loss, and reports as necessary to appropriate administration, committees, and personnel. maintains an incident reporting system by establishing a comprehensive incident reporting plan that establishes policies, educational programs, and reporting methods to the appropriate areas. Directs appropriate incidents to Medical Staff and Nursing peer review processes. Uses industry benchmarking to compare appropriate data. + Directs the risk investigation of all identified potentially compensable events (patient, visitor, employee, and product). Evaluates the investigation of all claim files on a routine basis in accordance with accepted standards. + Develops loss control measures relating to patient care complaints including, but not limited to, billing adjustments, access to medical care, and the provision of certain treatments when appropriate. + Maintains chain of custody on all medical records with outstanding claims, and maintains all evidence, documents, and communications on legal cases in a confidential manner. Sequesters medical records as necessary. + Acts as the spokesperson for the hospital and health system to persons who have a complaint that may be considered a potentially compensable claim. Aids the Patient + Relations Coordinator in analyzing patient complaints and directs inquiries to appropriate personnel. Insurance/ Legal Counsel – 20% + Presents summary information to outside legal counsel and Covenant Health Director of Risk Management with an opinion as to the potential for litigation. Manages the documentation and computerized files of all claims. + Assists the agents for the excess insurance carrier providing general and professional liability coverage in active case review. + Acts as liaison with insurance carriers and coordinates and prepares materials necessary for renewal of insurance applications. + Risk Programming – 20% + Develop and implements preventive risk management programs. Educates and trains staff in appropriate procedures, documentation, reporting, and follow-up in key areas of risk management interest. + Demonstrates knowledge and implementation of creative and innovative risk management processes. + Acts as liaison to outside litigation counsel in the management and investigation of filed lawsuits and related litigation processes. Understands the legal components of the risk management industry. + Serves as a resource to organizational staff on issues related to professional liability and other risks. Demonstrates role model behavior regarding proper customer satisfaction, conduct, confidentiality, complaint resolution, and problem-solving. Policies/ Procedures/ Regulatory – 20% + Assists with the review of the Risk Management Plan and all Risk Management policies as needed and at least once every two years. Proactively recommends appropriate revisions to new or existing policies and procedures to eliminate/reduce risk and to prevent future occurrences. + Prepares all necessary documentation and promotes compliance with regulations regarding areas of risk management responsibility, including but not limited to sentinel events and root cause analyses. + Promotes compliance with all applicable regulations including but not limited to the Safe Medical Devices Act (SMDA), Emergency Medical Treatment and Active Labor Act (EMTALA), and Health Insurance Portability and Accountability Act (HIPAA). Position Requirements + Minimum of a bachelor’s degree in healthcare administration or other healthcare related field. Master’s degree preferred. + Minimum of 5 years’ experience in healthcare related role. + Experience in Healthcare Risk Management of an acute-care hospital or other healthcare organization strongly desired. Willing to train the right candidate. + Certification in Healthcare Risk Management is strongly desired but not required.