Description:
Position Summary:
This position is responsible for providing strategic and operational leadership to the claims and litigation management team, the clinical risk management team, and the patient relations team. This includes implementation of best practices, financial responsibility for performance of claims including oversight of claim reserves and outcomes, and providing legal advice and direction related to risk management incidents and inpatient grievances, potential claims, claims and litigation. This leader provides direct reporting to the company's offshore captive insurance company board, and regularly interacts with domestic and international insurance market contacts. This position oversees Claims Directors managing their own caseloads and is also active in strategies, mediations and trials with cases involving potential for high exposure and ensures cost effective and successful management of Hospital and Physician Professional Liability (HPPL), General Liability (GL) and Employment Practices Liability (EPL) claims and litigation. This position has oversight for Clinical Risk Management Directors managing risk interacting with facility leadership teams across all care delivery sites for the organization. This position also incorporates and utilizes methods to improve all aspects of clinical risk management, quality and performance improvement, and patient safety, including overseeing the assessment and trending of liability exposures, identifying and directing risk mitigation strategies and providing consultation, education and coaching to assist Banner Health (BH) facilities and leaders in improving the quality of care, patient safety, and patient relations, and oversight of personnel responsible for the delivery of clinical risk management and patient relations at all BH facilities.
Core Functions:
Minimum Qualifications:
Bachelor's Degree in a relevant field or equivalent level of education and experience.
Expert-level working knowledge of principles, practices, and operations in assigned or related area of responsibility as normally obtained through a minimum of five to seven years of progressively responsible managerial experience, including a minimum of two to three years management level experience within a healthcare system setting or other large multi-operational, complex corporate environment.
This position requires completion of a Juris Doctorate (J.D.) and admission to at least one state bar, and a minimum of five to seven years medical professional liability management experience, either as in-house claims professional or outside counsel. Must gain admission to AZ bar through reciprocity or in-house counsel provision.
Must demonstrate expert-level knowledge and awareness of area of expertise in designated facility, business entity or area and/or experience in which the knowledge, skills, and abilities are directly transferrable. Proven track record of driving successful performance outcomes and accomplishing organizational goals. Must demonstrate skills and business acumen through direct leadership experiences such as: anticipating and responding to the needs of internal and external customers; managing a budget and financial plans; building partnerships with management, staff, and stakeholders to achieve department goals and objectives; managing problems and situations where uncertainty is inherent; persuading others to adopt a particular stance on an issue; developing and evaluating best practices and emerging trends for organizational applicability and appropriateness; constructing new and innovative solutions for complex and varying problems and situations while considering the larger perspective or context; mentoring and coaching staff by providing open and honest feedback to enhance performance; developing and implementing strategic goals and initiatives that support organizational success; demonstrating excellent human relations, organizational and communication skills; demonstrating a passion about continuously improving and providing high quality care and service excellence to customers, patients, families, employees and/or physicians.
Preferred Qualifications:
Strong negotiating skills and advanced knowledge of healthcare risk management, quality management and performance improvement preferred. Knowledge of in-house liability claims management processes and procedures and other related healthcare regulatory and/or litigation experience preferred.
Additional related education and/or experience preferred.
This position is responsible for providing strategic and operational leadership to the claims and litigation management team, the clinical risk management team, and the patient relations team. This includes implementation of best practices, financial responsibility for performance of claims including oversight of claim reserves and outcomes, and providing legal advice and direction related to risk management incidents and inpatient grievances, potential claims, claims and litigation. This leader provides direct reporting to the company's offshore captive insurance company board, and regularly interacts with domestic and international insurance market contacts. This position oversees Claims Directors managing their own caseloads and is also active in strategies, mediations and trials with cases involving potential for high exposure and ensures cost effective and successful management of Hospital and Physician Professional Liability (HPPL), General Liability (GL) and Employment Practices Liability (EPL) claims and litigation. This position has oversight for Clinical Risk Management Directors managing risk interacting with facility leadership teams across all care delivery sites for the organization. This position also incorporates and utilizes methods to improve all aspects of clinical risk management, quality and performance improvement, and patient safety, including overseeing the assessment and trending of liability exposures, identifying and directing risk mitigation strategies and providing consultation, education and coaching to assist Banner Health (BH) facilities and leaders in improving the quality of care, patient safety, and patient relations, and oversight of personnel responsible for the delivery of clinical risk management and patient relations at all BH facilities.
Core Functions:
- Provides leadership and direction to ensure cost effective and successful management of liability claims and litigation, including interacting with senior leaders of BH in decision-making on large litigation matters, the handling of claim files, creating reports, database entries, establishing and following standardized claims management procedures and other claims management responsibilities. Provides leadership for all aspects of Banner Health's clinical risk programs; leads, guides, directs, and evaluates the work of regional and facility risk management staff. Integrates objectives and clinical risk work with Banner Health disciplines and other corporate departments. Creates, monitors, and updates policies and procedures. Serves as a role-model for the organization's mission, vision, values, and behaviors.
- Provides direction and legal advice to Claim Directors and Specialists on claims and litigation matters and is active in management of cases with high potential exposure. Establishes and implements standardized excess reporting guidelines and reviews and responds to queries regarding excess carrier reports and loss runs. Oversees trial preparation for major claims. Within delegated authority limits, independently negotiates or directs the negotiation of the claims/lawsuits to resolution. Represents facility, physician, and/or organization at case evaluations, pre-mediation meetings with families and mediators, mediations, and trial.
- Provides legal advice and counsel to employees, leadership, and captive insurer relating to risk management issues, risk mitigation issues, and settlement and litigation strategies. Provides legal advice and direction to the organization with respect to incidents, potentially compensable events, claims or suits. Directs privileged investigations.
- Develops, participates in and coordinates internal and external claims audits, and leads claims team roundtable and reserve review processes. Monitors for and identifies system claim trends, as well as industry benchmarks. Prepares claims data reports and prepares case review materials. Presents comprehensive information at internal claim reviews and status reports to facility leadership, risk managers, facility administrators, medical staffs, various committees, executives and other as requested.
- Participates in the attorney selection and re-evaluation process. Retains approved defense counsel on a per claim basis and directs and supervises the work of outside defense counsel pursuant to litigation protocol. Partners with defense counsel to establish a claim resolution strategy, facilitates and communicates same. Provides guidance and clarity to other team members relating to litigated matters.
- Provide leadership in building consistency in risk management's practices. Identifies staffing needs and is responsible for the selection, training, supervision and professional development of personnel required to support clinical risk and patient relations programs. Implements procedures designed to facilitate the efficient and effective utilization of resources. Regularly consults with regional and facility-based risk managers.
- Develop and directs short- and near-term goals for the clinical risk and patients' relations teams. Makes recommendations for division annual strategic initiatives and budget; manages operations within approved budget.
- Collaborate with senior leaders and key stakeholders or experts, (e.g., Care Management, including Patient Safety, Legal, etc.) to develop system-wide responses to risk issues that impact specific groups or the entire System with policies/procedures, guidelines, tools, forms, and education/training. Participate and present, as directed, at System committees (i.e., BMG, Behavioral Health, etc.), Business Health, and captive insurance company board meetings and meetings with insureds and insurance underwriters. Implements and maintains programs that promote early identification and reporting of events involving serious injuries or probable liability, prompt investigation, disclosure, and proactive intervention to resolve potential liability events. Develop processes and benchmarks to monitor the effectiveness of risk mitigation strategies.
- Oversight for investigation and evaluation of complex claims and manages such claims through mediation and/or trial. Negotiates directly with claimants and attorneys on serious liability exposures. Supervises and mentor's others in the claims management department. Responsibility for the direction and management of clinical risk management and patient relations. Requires extensive interaction with all levels of senior management, physicians, CEO's, internal management, other BH personnel, attorneys, mediators, insurance companies, business personnel, and government agencies. Directs attorney-client privileged investigations. Has independent authority to resolve claims on behalf of the organization. Uses specialized knowledge and independent judgment to make operational, financial, and strategic decisions affecting outcomes throughout the company.
Minimum Qualifications:
Bachelor's Degree in a relevant field or equivalent level of education and experience.
Expert-level working knowledge of principles, practices, and operations in assigned or related area of responsibility as normally obtained through a minimum of five to seven years of progressively responsible managerial experience, including a minimum of two to three years management level experience within a healthcare system setting or other large multi-operational, complex corporate environment.
This position requires completion of a Juris Doctorate (J.D.) and admission to at least one state bar, and a minimum of five to seven years medical professional liability management experience, either as in-house claims professional or outside counsel. Must gain admission to AZ bar through reciprocity or in-house counsel provision.
Must demonstrate expert-level knowledge and awareness of area of expertise in designated facility, business entity or area and/or experience in which the knowledge, skills, and abilities are directly transferrable. Proven track record of driving successful performance outcomes and accomplishing organizational goals. Must demonstrate skills and business acumen through direct leadership experiences such as: anticipating and responding to the needs of internal and external customers; managing a budget and financial plans; building partnerships with management, staff, and stakeholders to achieve department goals and objectives; managing problems and situations where uncertainty is inherent; persuading others to adopt a particular stance on an issue; developing and evaluating best practices and emerging trends for organizational applicability and appropriateness; constructing new and innovative solutions for complex and varying problems and situations while considering the larger perspective or context; mentoring and coaching staff by providing open and honest feedback to enhance performance; developing and implementing strategic goals and initiatives that support organizational success; demonstrating excellent human relations, organizational and communication skills; demonstrating a passion about continuously improving and providing high quality care and service excellence to customers, patients, families, employees and/or physicians.
Preferred Qualifications:
Strong negotiating skills and advanced knowledge of healthcare risk management, quality management and performance improvement preferred. Knowledge of in-house liability claims management processes and procedures and other related healthcare regulatory and/or litigation experience preferred.
Additional related education and/or experience preferred.
