Develops clinical risk management guidelines, policies, processes and procedures for response to Clinical Risk and in collaboration with nurse leadership and addresses patient safety concerns.
Performs initial review of care and suggestions for physician-assisted review. Provides preliminary assessment of clinical risk exposure to necessary personnel. Provides advice/decision support by developing comprehensive strategies, plans and systems/processes to achieve identified Leads and oversees the risk program.
Performs EHR reviews to identify quality issues and areas of risk and formulate corrective action plans or mitigation strategies.
Identifies, analyzes and acts upon actual and potential exposures to the organization with a goal of improved patient safety and protection of the organization’s assets.
Maintains the incident reporting system. Collects, evaluates, and reports on events and incidents. Performs statistical analysis and trending of events and leads the proactive assessment and develops mitigation and sustainable strategies for clinical risk vulnerabilities.
Develops and implements project plans with identify improvement opportunities, key issues, approaches, performance metrics and required resources.
Provide support to the clinical operations team in risk management areas; responds to staff inquiries regarding clinical operational issues. Coordinates or conducts annual proactive risk assessments in collaboration with other disciplines to identify opportunities to improve reliability in processes and reduce risk. Assists Providers and staff with potential clinical and non-clinical risk issues.
Promote an organizational culture that allows safety issues to be openly reported, discussed and addressed. Serves and is known as a key liaison, problem solver, and provides guidance to team.
Develops and presents educational programs for providers, managers and others. Facilitates organizational awareness and handling of Clinical Risk Management matters. Coordinates and delivers risk management education, training and communication programs for AltaMed sites. Educate staff and physicians in collaboration with Education Department on Risk Management strategies to mitigate loss and improve reporting in a just culture; educates and assists other managers in assessing their areas of responsibility for exposures to loss and unsafe processes and conditions.
Assists with communication and documentation of errors or serious events in accordance with legal requirements and/or accreditation standards.
Reports trended data and mitigation actions to the appropriate committees, departments and individuals.
Leads the Failure Mode Effect Analyses and Root Cause Analyses investigations and develops action oriented recommendations to correct and/or eliminate deficiencies that may adversely affect patients, visitors and staff.
Coordinates clinical risk orientation and continuing education programs for providers, management and staff to enhance awareness of their role in high reliability, just culture, patient safety, clinical risk reduction and event reporting. Ensures that recommendations are monitored and tracked to completion.
Ensures the thorough review of medical discrepancies, analysis of data and follow up actions to improve patient care and patient safety.
Reviews and revises the clinical risk management program at least biannually; prepares reports on professional liability cases and risk management patterns, trends and issues including loss prevention, patient safety and risk reduction.
Works with Product Evaluation Committee in the selection and procurement of clinical supplies and equipment needed in the clinical areas
Oversee/manage a system for tracking and trending of potentially high risk behavior leading to patient, staff and visitor injuries.
Performs patient safety rounds and environment of care rounds in collaboration with the Patient Safety Specialist and the EOC team.
Ensures compliance with various codes, laws, rules and regulations concerning patient care/safety, including those mandates by state and federal agencies. Assists in ensuring compliance with regulatory requirements, including The Joint Commission, CMS , NCQA and Heath Plan requirements
Collaborates with PCS, Managed Care and the Quality Department in matters related to regulatory compliance, policy planning and implementation and contract management.
Maintains strict privacy and confidentiality of information pertaining to physicians, and reports non-compliance with applicable federal, state, and other policies to proper individuals.