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Director, Risk Management & Accreditation

Bakersfield, CA, USA | Adventist Health

  • Industry:
    Healthcare - Hospitals
  • Position Type:
  • Functions:
    Risk Management
  • Experience:
    7-10 years
Job Description:
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We're looking for someone to join our team as a , Risk Management & Accreditation who:

Maintains responsibility for the direction and management of the department. Oversees risk management activities including processing claims filed against the facility, interfacing with defense legal counsel, administering educational programs and complying with risk management related standards set by Joint Commission and other regulatory agencies. Leads with objective of enhancing/promoting patient safety, ensuring quality care and minimizing loss to protect the assets of the organization. Supervises and directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment.

Essential Functions:

Coordinates organization's readiness rounds program and maintains responsibility for the development, communication, implementation and tracking of action plans necessary to close identified gaps in care/compliance. Checks regulatory websites for new information and is instrumental in developing assessments and achieving organization readiness. Educates the organization on regulatory and accreditation issues and follows up on Sentinel Event Alerts. Tracks, reports and ensures the completion of action items resulting from compliance reviews. Analyzes and investigates serious safety events in support of the patient safety program.

Creates reports after review of unusual occurrence and adverse events, and alerts appropriate regulatory body. Develops and implements appropriate measures to identify/minimize risk of injury to patients, visitors and staff, and to minimize loss or damage to property. Receives incident reports and other information regarding untoward occurrences in the facility, such as assurance outliers or variations. Collates information systematically to permit analysis pursuant to risk management policy/procedures. Maintains responsibility for implementing, coordinating and monitoring risk management programs including risk detection, assessment and prevention. Facilitates analysis teams and proactive risk assessments. Develops, maintains and updates policies/procedures relating to risk management, patient safety and customer service claims staff. Risk Management / Liability Claims Liaison: Acts as Site Administrator for RADAR Claims Module (Potentially Compensable Event) and maintains legal case files. Investigates and reports potentially compensable events (PCEs) and asserted claims (demands for compensation, services or litigation) to the Trust pursuant to the corporate policy for reporting to the Trust. Provides investigation findings/information to claims staff including identity of location/site/clinic involved, identity (full name, job title) of involved parties, witnesses (how they are/were involved) etc., narrative description of the events, issues identified and recommendations for additional investigation. Investigates and responds (in writing) to requests from patients/visitors for compensation or payment for services, e.g., physical therapy, home health, specialist consultation, etc. Serves as primary contact for defense counsel and corporate claims staff. Facilitates/verifies discovery and requests for documents, information, interviews and depositions. Obtains concurrence for settlement, trial, etc. Works with legal counsel to coordinate investigations, process and defend claims against the facility. Obtains/maintains records and documents and provides them to defense attorneys for preparation of testimony in pending litigation. Safeguards materials obtained or developed for root cause analysis to ensure documents/proceedings are protected from discovery. Initiates and monitors efforts to preserve evidence, i.e., surveillance video, equipment memory, etc., and/or litigation holds. Attends trial as site representative, coordinates litigation activities involving site interviews, depositions, witness preparation, etc. Approves payment for replacement of lost property after claim evaluation. Negotiates settlement of small claims within administrative authority and advises collection department of appropriate action for unpaid accounts involved in litigation.

Performs other job-related duties as assigned.

You'll be successful with the following qualifications:


's degree in nursing, business administration, hospital administration or equivalent combination of education/related experience: Required

's degree: Preferred

Work Experience: 

Seven years technical experience: Preferred

Five years leadership experience: Preferred

years clinical experience: Preferred

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