Insurance Risk Manager Jobs in Louisiana (NOW HIRING)

POSITION SUMMARY

Reporting to the Director of Quality Management and working in partnership with the CMO, Senior Leadership Team, and other hospital leaders, will investigate, resolve, document and report patient and visitor compliments and concerns. Facilitate resolution of complaints and grievances of patients, family members, and visitors. Develop, implement and participate in customer service and patient relation initiatives. Provide monthly accountability and variance analysis of customer service outcomes. Coordinates all aspects of risk management that protect the hospital's present and future assets from risk and liability by preventing or minimizing the occurrence of risk and its effect, financial or otherwise. To ensure patient safety and improve quality patient care by managing incident reporting and identifying patterns and/or trends that have the potential to result in patient, visitor and/or employee injury.

DUTIES AND RESPONSIBILITIES

• Annual completion of three to five process improvement projects per year with pre-established baseline improvement related to patient care, patient perception of care, increased efficiencies and/or enhancement of revenue stream per project.
• Provide assistance and resource to service departments and business units in identifying, planning and implementing customer service initiatives.
• Investigate complaints and grievances. Work collaboratively with physicians, directors and managers of the involved units to develop a response to the complainant and an action plan to address identified opportunities for improvement. Responses to complainant must be completed in a timely manner in accordance with the complaint/grievance policy.
• Responsible for education, training, and orientation of hospital leadership with performance improvement tools and organizational development best practice.
• Has expert knowledge in customer satisfaction/service, patient complaint/grievance processes as it relates to the vendor program utilized for customer satisfaction, HCAPHS requirements, requirements from other outside licensing/accreditation body including DNV and CMS Conditions of Participation.
• Analyze complaint and grievance data on a monthly and quarterly basis looking for opportunities and trends. Report quarterly data to Quality Council.
• Facilitates the Hospital Grievance Committee or participates in the Hospital Patient Safety Triage Team (PSTT) to report outpatient complaints and grievances and gather information for resolution and communication back to the complainant.
• Responsible for creativity, innovation, and value brought to the facility for implementation of these programs throughout departments.
• Employee displays knowledge of basic components of risk management, including potentially compensable events, risk investigation and reporting.
• Employee conducts analysis of Occurrence Reports to identify trends or patterns and makes recommendations to administrative personnel.
• Employee reviews and refers information gathered from Occurrence Reports to appropriate department manager/administrative personnel member and/or hospital mechanism for analysis and corrective action to eliminate or reduce risk.
• Employee works closely with the Quality Director to coordinate and/or conduct Root Cause Analyses when an adverse event, or an event that can potentially result in an adverse event, occurs.
• Employee works closely with the Compliance Officer to investigate EMTALA or possible EMTALA violations.
• Employee conducts Rounds throughout the hospital to ascertain whether precautions and hospital policies are followed in order to minimize risk.
• Employee interacts professionally with patient/family to diffuse potential litigious occurrences related to patient/family dissatisfaction.
• Ensures the CARES behavior standards are effectively implemented within the facility.
• Develops tools/programs/education for change behavior/improvement.
• Ensures the data results/patterns/trends are identified, reported, analyzed, prioritized, and corrected through appropriate hospital and medical staff action committees'/work groups/teams.
• All other duties as assigned

SKILL REQUREMENTS

• 3 to 5 years of Performance Improvement and/or Organizational Development Experience, Service Excellence Experience, training professional with proven skills in project facilitation. Management experience preferred.
• Process improvement background within healthcare or hospitality; knowledge of HCAHPS / Patient Satisfaction survey process required; knowledge of customer service management models. Lean Six Sigma, continuous quality improvement, basic probability and statistics experience preferred.
• Proven record of performance and ability to create and sustain measurable outcomes; coach and mentor others toward positive outcomes; experienced team leader with problem solving experience. An individual who can work well under pressure or in stressful and demanding situations or environments.
• Excellent communication skills, both written and oral.
• Ability to communicate effectively with all levels of staff and the community.
• Good computer skills
• Self-directed and self-motivated

EDUCATION AND EXPERIENCE REQUIREMENTS

• Bachelor's degree in healthcare administration, Nursing, or another related field required
• Masters preferred
• Hospital Risk Management experience preferred.

Please indicate whether you have ever been convicted of a crime, including any misdemeanors and/or DUI/DWI. (Criminal conviction(s) will not automatically exclude you from consideration for employment).