Under the guidance of the Director of Compliance and Risk and the Risk Management Chair:
Responsible for leadership of IHA's risk management activities in both the inpatient and outpatient settings, which includes, but may not be limited to: Daily support for IHA's risk management program by serving as a clinical resource for risk prevention, enhancing quality care, confirming insurance coverage, monitoring claims, and minimizing loss exposures to protect the assets of the facility.
Responsible for identifying, assessing, and recommending corrections for all areas of risk in an effective manner. Assures adherence to all government regulations and accrediting body standards, organizes and implements policies and procedures necessary to support risk structures and processes; This position serves as a point of contact for risk management concerns, both new and ongoing.
The position is responsible for identifying internal health system quality and safety issues and analyzing the root causes and underlying factors. This Manager promotes the organizational patient safety initiatives and works with other Directors, Managers, Supervisors and medical staff leadership to develop process changes and improvements, serves as a point of contact for IHA claims with IRMS and works to develop risk mitigation strategies and education.
ESSENTIAL JOB FUNCTIONS:
Develops, coordinates, and administers facility-wide systems for risk identification, investigation and reduction; performs risk surveys to assess loss potential. Performs routine audits of and monitors risk functions.
Collects, evaluates and distributes relevant data concerning patient events. Performs proactive analysis of patient safety and medical errors and processes. Participates in root cause analysis and learning from defects. Provides aggregate date analysis of risk data; maintains statistical trending of losses and other risk management data. Follows up on action items and tasks assigned in safety learning events.
Reviews policies, processes to formulate potential for organizational changes, and makes recommendations for approval by senior leadership. Informs directors of service and department heads regarding occurrences, issues, findings and risk management suggestions; provided feedback to directors to eliminate risks; assists the Director of Compliance and Risk Management and Dept. Chairs in designing risk management strategies.
Participates on committees directed towards promoting patient safety and risk management work. Serves as IHA liaison for all risk related legal matters. Prepares files and agenda for IHA's Risk Management Committee. Attends and participates in Trinity Health Risk committee activities as requested.
Monitors and manages legal case files; ensures all active risk management cases are properly logged and kept current; Responds to requests for claim information; Works with IHA Physicians and Managers to gather information; Responds to request to gather employment dates for insurance verification purposes.
Works with legal counsel and or other IRMS associates to coordinate the investigation, processing and defense of claims against IHA. Records, collects, documents, and maintains information needed by IHA in the defense of our claims or submit for claim reimbursement.
Maintains risk management statistics, claims files that are up to date and in compliance with state and federal agencies.
Promotes accurate and complete medical record integrity. Directs and coordinates release of records and information in response to subpoenas, court orders, attorney requests, state and federal agency investigations and other inquiries on records legal questions and depositions;
Receives, develops and communicates appropriate responses to risk events and medical care complaints with appropriate physician peer review. Works to resolve complaints in a fair and professional manner.
Serves as a point of contact for IHA risk management concerns, both new and ongoing; provides guidance for IHA Providers and Practice Managers on risk related issues; Responds appropriately to risk related questions.
Responsible for completion of annual IRMS insurance policy renewal. Submits recommendations for changes in the existing risk control and risk-financing procedures based on changes in operations, property or activity.
Recommends appropriate revisions to new or existing policies and procedures to reduce the frequency of future occurrences. Develops and implements risk prevention strategies through system changes; works through the IHA Risk Management Committee to identify areas where policy development will benefit IHA's overall risk plan.
Manages electronic information database for investigative activity; Utilizes data from trend analysis for the identification of opportunities to strengthen internal processes and minimize risk areas.
Advises Senior Management and IHA Risk Management Committee regarding the development and implementation of risk strategy, potential areas of concern, and new regulations or developments.
Develops, implements a comprehensive compliance work plan and long-term strategy in order to effectively manage and mitigate any identified compliance risk factors.
Manages improvement activities related to issues that are connected to event reports, peer review, root cause analysis, and other patient safety concerns, including serving as a resource risk related questions for Joint Commission activity.
Manages the development and implementation of a relevant and comprehensive risk education curriculum in collaboration with IHA's Learning and Development Department where appropriate. Partners with IHA Human Resources to support coaching opportunities.
Serves as administrative support to the IHA Risk Management Committee; develops meeting agenda, prepares reports, summaries and packets and maintains meeting notes.
Conducts an enterprise wide risk assessment for IHA on at least an annual basis, in collaboration with Compliance team. Proactive analysis of patient safety and facility safety.
Maintains knowledge and complies with applicable healthcare laws, regulations and standards concerning patient care. Maintains awareness of legislative activities that may affect risk management programs.
Performs other duties as assigned.
Creates a positive, professional, service-oriented work environment by supporting the IHA CARES mission and core values statement.
Must be able to work effectively as a member of the Compliance team.
Successfully completes IHA's "The Customer" training and adheres to IHA's standard of promptly providing a high level of service and respect to internal or external customers.
Maintains knowledge of and complies with IHA standards, policies and procedures, including IHA'sEmployee Handbook.
Maintains general knowledge of IHA office services and in the use of all relevant office equipment, computer, and manual systems.
Serves as a role model, by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences.
Uses resources efficiently.
Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.
EDUCATION: Bachelor's Degree or equivalent combination of education and experience.
CREDENTIALS/LICENSURE: Registered Nurse, with current State of Michigan licensure; Certified Professional in Healthcare Risk Management (CPHRM) or FASHRM is required to obtain.
MINIMUM EXPERIENCE: 4 or more years' experience in the following areas: Compliance, HIPAA, healthcare risk management, regulatory standards, patient safety, or other relevant area; prior clinical experience is required.
POSITION REQUIREMENTS (ABILITIES & SKILLS):
Knowledge of federal, state, and insurance company regulations and contract requirements affecting compliance in a healthcare setting; understands managed care and insurance practices.
Understanding of insurance claims and billing process; HMO, PPO, TPA and commercial insurance types; fee schedules and pricing.
Well-developed understanding and/or hands on experience with office processes, procedures and workflows.
Maintains deep working knowledge on insurance billing and coding requirements, rules and regulations for government and private payers.
Knowledge of Compliance plan and auditing standards, organization policies and procedures.
Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, Microsoft Word and Excel, intranet and computer navigation. Ability to use other software as required while performing the essential functions of the job including EPM and EHR systems.
Proficiency in planning, organizing and prioritizing workloads.
Ability to develop and maintain effective professional working relationships with all levels within IHA as well as outside contacts.
Effective, professional communication skills, verbal, written and during group presentations.
Ability to coordinate activities and work independently to complete projects requiring highly complex analysis.
Works collaboratively in a team-oriented environment; courteous, professional and friendly demeanor.
High level of organizational and time management skills with ability to effectively juggle multiple priorities and time constraints in a fast-paced environment.
Exercise sound judgment and problem-solving skills.
Ability to analyze complex data to monitor IHA's compliance with our standards and billing practices, and procedures; Ability to analyze RBRVU data fields in correlation to IHA fee schedule.
Ability to maintain any organizational information in a confidential manner.
Successful completion of IHA competency-based program within introductory and training period.
Ability to work overtime hours as scheduled.
MINIMUM PHYSICAL EXPECTATIONS:
Physical activity that often requires keyboarding, filing and phone work.
Physical activity that often requires extensive time working on a computer and sitting.
Physical activity that sometimes requires walking, bending, stooping, reaching, and/or twisting.
Physical activity that sometimes requires lifting, pushing and/or pulling under 30 lbs.
Specific vision abilities required include close vision, depth perception, peripheral vision and the ability to adjust and focus.
Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.
MINIMUM ENVIRONMENTAL EXPECTATIONS:
This job operates between working in a typical office environment which involves frequent interruptions and interaction with people which can be stressful at times.
Internal Number: 10001
Headquartered in Ann Arbor, Michigan, IHA is one of the best and largest multi-specialty groups in Michigan delivering more than one million patient visits each year. IHA employs more than 2,200 staff, including more than 650 providers consisting of physicians, nurse practitioners, physician assistants and midwives in approximately 70 practice locations across Southeast Michigan. Recognized as Metro Detroit’s Top Physician Group by Consumer Reports magazine, IHA also ranks in the top quartile for patient, staff and provider satisfaction nationally. IHA offers patients extended office hours and urgent care services, along with online patient diagnosis, treatment and appointment access tools. IHA is a wholly-owned subsidiary of Saint Joseph Mercy Health System and a member of Trinity Health.
Here are a few facts about IHA to help you understand our impact on the communities we serve in Washtenaw, Livingston, Lenawee, and western Wayne Counties:
Office Locations: More than 70
Active Patients: More than 485,000 patients
Babies Delivered: 3,583 last year (2017)
Nurse Practitioners/PA-C's/Certified Nurse Midwives: 138
Board Certified/Eligible Ph...ysicians: 100%
Hospital Affiliations: St. Joseph Mercy Ann Arbor, St. Joseph Mercy Chelsea, St. Joseph Mercy Livingston, St. Mary Mercy Livonia, Michigan Medicine
Support Staff: Over 1,600
To improve the patient experience by providing health care providers; patients and their families; and others with information, education, networking opportunities, and related resources focused on best practices.