Director of Risk Management

The Risk Manager is responsible for the leadership and professional management of South County Health's comprehensive risk management and patient safety program. This role ensures a proactive approach to risk identification, mitigation, and compliance, a culture of safety, transparency, and accountability throughout the organization.

Responsibilities

• Lead and oversee the hospital-wide risk management and patient safety program.
• Reduce preventable accidents, injuries, and adverse events while improving patient outcomes through ongoing risk assessment and intervention.
• Develop, present, and evaluate risk-focused education for providers, nurses, new employees, and other staff to promote patient safety and minimize claims exposure.
• Provide on-call support and timely consultation on risk-related issues for staff and providers.
• Maintain current knowledge of best practices, regulatory standards, and trends in loss prevention, malpractice, and risk management.
• Prepare and present reports and data related to risk, patient safety, claims, and regulatory compliance to committees, leadership, and medical staff.
• Manage the risk and feedback software reporting systems.
• Ensure timely submission of required safety events to the contracted Patient Safety Organization in compliance with federal regulations.
• Lead investigations, root/apparent cause analyses, action plans, and follow-up for sentinel events, certain near misses, and DOH-reportable events.
• Review and update hospital administrative policies along with certain patient care policies, to ensure compliance with current regulations and best practices.
• Direct the system's insurance program, including the self-insured trust, commercial policies, and employed physicians' coverage.
• Manage policy renewals, ensuring accurate and timely completion of all applications and required documentation.
• Report actual and potential claims promptly to appropriate carriers and coordinate follow-up as needed.
• Provide loss run data and certificates of insurance (COIs) for advanced practice providers and physicians, both routinely and at annual renewal.
• Oversee processes for new provider insurance quotes and approval, along with extended reporting period (ERP) or tail coverage for departing physicians.
• Manage and participate in all aspects of professional and general liability claims and litigation, along with certain other coverages.
• Maintain complete and accurate claims and litigation files within the claims module software.
• Oversee and respond to legal discovery requests, including document production and interrogatories.
• Coordinate meetings, depositions, and testimony between staff and legal counsel.
• Serve as liaison with insurance carriers, claims representatives, and legal counsel.
• Manage service of subpoenas, ensuring accuracy, validity, and appropriate handling for hospital staff, providers, and employed physicians.
• Report professional liability claims and suits under the self-insured trust to the Rhode Island Department of Business Regulation (DBR) as required, both individually and annually.
• Monitor for DOH-reportable events and ensure timely, accurate reporting and investigation.
• Coordinate root cause analyses, action plans, and leader follow-up for reportable events.
• Maintain readiness for DOH surveys and assist surveyors with records and information requests.
• Complete and submit the hospital's annual DOH license renewal.
• Respond to DOH licensing board requests and subpoenas (e.g., medical and nursing).
• Ensure hospital compliance with HIPAA regulations through education, monitoring, and system-wide auditing.
• Investigate privacy and breach incidents and allegations, coordinating corrective actions and responses to impacted parties, along with reporting to the U.S. Department of Health and Human Services and the Office for Civil Rights as applicable.
• Respond to the U.S. Department of Health and Human Services and the Office for Civil Rights as required in matters involving breaches or investigations.

Minimum Qualifications

• Holds current CPHRM credential or meets Education/Healthcare and Risk Management Experience requirements for eligibility to test for certification as specified below:

• Baccalaureate degree or higher from an accredited college or university plus five (5) years of experience in a health care setting or with a provider of services to the health care industry, or
• Associate degree or equivalent from an accredited college plus seven (7) years of experience in a health care setting or with a provider of services to the health care industry, or
• High school diploma or equivalent plus nine (9) years of experience in a health care setting or with a provider of services to the health care industry.

• Risk Management Experience

• 3,000 hours or 50 percent of full-time job duties within the last three years dedicated to health care risk management in a health care setting or with a provider of services (e.g. consultant, broker, or attorney) to the health care industry.

Required Certifications, Licensure

• Certified Professional in Healthcare Risk Management (CPHRM) or within one year of hire.