JOB SUMMARY

Manages detailed, comprehensive, timely assessment of high-risk claims with a medical/legal plan of action developed to prevent elevation to a claim.  Reviews, identifies and evaluates potentially compensable events (PCEs) cases as early as possible for Baylor Scott & White Health (BSWH).  Collaborates with leadership, clinicians, medical providers and team members on enterprise risk management initiatives and minimizing the organization?s overall exposure to risk.

ESSENTIAL FUNCTIONS OF THE ROLE

• Reviews incident reports to assess potentially compensable events (PCEs) for further investigation.
• Disseminates investigation findings and notifications/complaints received related to potential liability and transmits that information to Risk Management legal counsel when appropriate. 
• Interacts with clinicians, medical providers, leadership and staff for timely reviews, feedback, recommendations and resolution to professional liability claims.  Coordinates timely follow-up and collaborates with multiple reviewers to ensure timely response.
• Oversees reviews with designated Patient Relations staff to enable timely review of cases to meet regulatory requirement guidelines as applicable.  Reviews patient complaints that may be the source of potential legal action, discusses and offers solutions when possible to resolve with patient and/or family those grievances that may be perceived as potential liability claims, and supports proper investigation and resolution.
• Enters and supports all required data elements, study and outcomes in the Risk Management database per deadlines and reporting purposes.
• Ensures that medical records, patient billing records, incident reports, medical examiner?s reports (if available) is obtained and managed as a critical aspect of the review process.  All documents are maintained and secured for documentation purposes with special billing arrangements for handling made as appropriate.
• Prepares comprehensive, written case summaries for reporting to meetings, depositions and to assist outside litigation.  Provides professional and concise verbal presentations of PCE cases at scheduled Risk Management Department meetings, System meetings and other meetings as requested.  Compiles reports and data study requests as requested to support BSWH Risk Management.
• Acts as a liaison between attorneys, clinical staff and medical providers in matters involving outside meetings, depositions and narratives.

KEY SUCCESS FACTORS

• Exceptional understanding and experience with healthcare professional liability along with safety, risk, and quality concepts.  Good experience utilizing quality improvement methods and tools preferred.
• Ability to collect and examine data utilizing statistical methods to recognize trends and drive change.
• Excellent verbal and written presentation skills.
• Highly developed interpersonal, leadership, and team building skills with the ability to interact well with all levels of the organization including administration, professional staff, and front-line staff.
• Advanced skill set in the use of computers and related software including Microsoft Office Suite and other applications.
• Maintains current knowledge of state and regulatory standards for compliance and assists the department in maintaining compliance with all applicable standards.

BENEFITS

Our competitive benefits package includes the following

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

• EDUCATION - Associate's or 2 years of work experience above the minimum qualification
• EXPERIENCE - 5 Years of Experience

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About Baylor Scott & White Health

Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!

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