Medical Management Director jobs in Washington
Medical Management Director directs and oversees the operations and strategic planning of the organization's medical management initiatives and programs. Establishes case management, utilization review, quality and outcome management, and community education programs to provide high quality, cost effective health care services. Being a Medical Management Director develops and implements clinical guidelines for care designed to improve outcomes while managing costs. Requires a bachelor's degree. Additionally, Medical Management Director typically reports to top management. The Medical Management Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Medical Management Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
Recently Added Medical Management Director jobs
Director Risk Management
- UW Medicine/Valley Medical Center
-
Renton, WA
FULL_TIME
-
Job Description
Risk Management
The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.
TITLE: Director Risk Management
JOB OVERVIEW: The Director, Risk Management is responsible for all aspects of protecting Valley Medical Center from the financial impact of accidental loss.
DEPARTMENT: Risk Management
WORK HOURS: As required to fulfill responsibilities
REPORTS TO: Valley Medical Center General Counsel and Director UW Medicine Risk Management
PREREQUISITES:
Master's degree or equivalent experience (9 years). Preferred areas of graduate study include public health, health administration or nursing. Juris Doctorate preferred.
Minimum four years' experience managing professional liability events in a health care Risk Management setting and/or professional liability claims experience.
Minimum 3-5 years experience as a clinician (preferred) and/or equivalent work experience in a health care setting, preferred.
Minimum 3-5 years experience working with the public to resolve disputes or equivalent work experience, preferred.
Minimum 3-5 years experience developing and using databases to report information, preferred.
Risk Management credentials, such as the Associate in Risk Management (ARM) or Chartered Property Casualty Underwriter (CPCU) or certificate program in Healthcare Risk Management (CPHRM), preferred.
QUALIFICATIONS:
Demonstrated proficiency in mentoring colleagues.
Experience-based knowledge of medical professional liability exposures and laws, investigation and negotiation techniques.
Thorough knowledge of the principles and practices of Risk Management.
Effective and professional oral and written communication skills.
Proven ability to organize and analyze data and to problem-solve using continuous quality improvement techniques to improve processes and outcomes.
Demonstrated familiarity and ability to use Word & Excel and similar software products independently.
UNIQUE PHYSICAL/MENTAL DEMANDS, ENVIRONMENT, AND WORKING CONDITIONS: Works at a computer for extended periods of time. Travels to various departments, including off-site locations, as needed for site assessments, educational programs, and consultations. Available for emergency consultations as needed during off-hours, via phone. Safety position requires work to be performed both inside and outside, in all types of weather as required. Individual can potentially be exposed to refrigerator burns, infections, chemicals, gases, bruises, cuts, electrical shocks, dust, dirt and skin and lung irritations. When working in a hazardous location the employee is required to utilize proper safety clothing, gear and equipment. This position requires occasional irregular hours.
PERFORMANCE RESPONSIBILITIES
A. Generic Job Functions: See Generic Job Description for Administrative Partner
B. Essential Responsibilities and Competencies:
Claims Management Responsiblities:
Leads the operational, planning and personnel activities of the claims program, including assignment of claims, managing an individual case load, and leadership of the healthcare professional liability, liability program. May supervise work of third party administrators and adjusters. Works with insurance brokers and other advisors to manage claims program effectively and efficiently.
Direct oversight of complex liability claims, including:
Investigating claims and lawsuits
Determining appropriate coverage source for entities and individuals named in claims and lawsuits
Collaborating with co-defendants, including UW Medicine, within legal privileges and constraints of insurance program
Evaluating liability and damages
Setting and updating reserves accurately
Analyzing defense and indemnification requests
Consulting with experts, attorneys and others
Communicating clearly and fairly with claimants and insureds
Selecting defense counsel
Developing and implementing claims action plans
Managing discovery
Negotiating settlements within delegated authority; obtaining authority for amounts in excess of delegation
Executing settlement agreements
Preparing and monitoring a case through trial
Communicating lessons learned from claims and lawsuits
Entering claim information into claims data base consistent with data integrity standards.
Develops and presents medical malpractice claims reports to the Risk Management Committee as required.
Reports claims to excess insurers/reinsurers as needed on claims and fulfills their communication and timeliness requirements. Reports to excess insurers on "circumstances" identified by the clinical risk management program.
Prepares reports to the State Disciplinary Boards, the National Practitioner Data Bank and other regulatory bodies as required for medical malpractice claims. Recommends allocation of financial responsibility among named defendants.
Develops and executes communication strategies with internal clients, insurers, adjusters, and service providers so that information needs are met and claims outcomes are optimized. Maintains effective, positive communication with General Counsel, outside counsel, insurers, insurance brokers, and other strategic partners.
Analyzes losses and recommends strategies to reduce losses. Consults with General Counsel and others on optimal risk transfer strategies based on loss experience.
Develops and implements best practices for the claims program. Stays abreast of national and local trends and analyze pertinent state and national legislation. Develops and maintains optimal claims management tracking systems. Ensures data integrity and sufficiency. Develop and implement procedures necessary for the data and document collection, communication, and retention necessary for Valley's captive insurance company, underwriters, actuaries, auditors, and regulators. Ensure that data and work processes are compliant with state and federal privacy laws. Direct the work of coverage counsel when required.
Clinical Risk Management Duties:
Plans, implements, and directs the clinical risk management program and the patient relations activities of Valley Medical Center in accordance with the hospital's and Health Sciences & UW Medicine Risk Management's (HSRM) standards and procedures to prevent and reduce liability exposures related to patient care delivery. This includes:
Directs and provides services to identify and resolve clinical risk management issues associated with adverse patient events in active collaboration with quality improvement, medical staff office, and patient safety programs in event reviews as part of the entity and/or UW Medicine's quality improvement program procedures. Manages charge waivers in accordance with UW Medicine Compliance policy and applicable law. This includes:
Development of systems for the regular review of events (incidents) to identify those requiring further investigation, including reports as circumstances to underwriters.
Supervision and/or implementation of investigation plans in collaboration with clinical leaders, quality improvement and patient safety staff members
Maintenance of investigation records in accordance with department and VMC procedures for record retention
Directs the activities of Valley Medical Center's patient relations program and program staff to restore positive patient relations by identifying and resolving service quality or clinical risk management concerns.
Develop, implement and maintain effective systems for the regular management of patient complaints and grievances, including the documentation standards and management of entity's committee oversight.
Supervise or manage grievances in accordance with entity policies and procedures, state and federal regulations, and accreditation standards
Provides leadership in the development and/or implementation of risk management policies and procedures. May assume primary responsibility for authoring risk-related UW Medicine policies that are implemented at all UW Medicine entities.
Consultation Services: Supervises or provides consultation support to assigned entities regarding medical legal topics such as disclosure of unanticipated outcomes of care, informed consent, termination of patient care, patient rights and end-of-life decisions. Serve on assigned entity-level committees such as quality oversight committees
Clinical Risk Management Education: Plans and delivers regular clinical risk management education programs to orient the staff of assigned entities to clinical risk management topics. Develops targeted educational interventions in response to emerging trends or changing law or standards.
Leaderhsip:
Supervision of all program staff.
Responsible for programmatic accreditation/regulatory compliance for department records associated with claims, clinical events and grievances, including but not limited to DOH Adverse Event Reporting, TJC Sentinel Event review criteria, FDA Safe Medical Device report criteria, CMS Conditions of Participation, HIPAA and the healthcare information act, account waivers accomplished in compliance with the False Claims Act, and other regulations and standards as applicable. Assures that records created by assigned staff are kept and maintained in accordance with department procedures and the relevant record retention schedules.
Ensures the accurate capture of investigation activity in information systems in accordance with VMC risk financing needs HSRM department procedures and the relevant record retention schedules. Manages the use of reports from information systems to drive medical malpractice prevention and quality improvement efforts and to provide appropriate education to clinicians to reduce the risk of patient harm.
Management of the Risk Management Committee meeting, including preparation oversight with key team members, including Executive team/Medical Staff Leadership and quality improvement and patient safety partners. The committee also serves as the Grievance Committee required by CMS regulations. This includes agenda development and ensuring that timely and accurate meeting minutes are produced and retained.
May represent the HSRM department at UW Medicine-level committees, meetings or task forces at the request of the director, HSRM
Performs other related job duties as required.
Revised: 3/21
Grade: NC32
FLSA: E
CC: 8710
PREREQUISITES:
Master's degree or equivalent experience (9 years). Preferred areas of graduate study include public health, health administration or nursing. Juris Doctorate preferred.
Minimum four years' experience managing professional liability events in a health care Risk Management setting and/or professional liability claims experience.
Minimum 3-5 years experience as a clinician (preferred) and/or equivalent work experience in a health care setting, preferred.
Minimum 3-5 years experience working with the public to resolve disputes or equivalent work experience, preferred.
Minimum 3-5 years experience developing and using databases to report information, preferred.
Risk Management credentials, such as the Associate in Risk Management (ARM) or Chartered Property Casualty Underwriter (CPCU) or certificate program in Healthcare Risk Management (CPHRM), preferred.
QUALIFICATIONS:
Demonstrated proficiency in mentoring colleagues.
Experience-based knowledge of medical professional liability exposures and laws, investigation and negotiation techniques.
Thorough knowledge of the principles and practices of Risk Management.
Effective and professional oral and written communication skills.
Proven ability to organize and analyze data and to problem-solve using continuous quality improvement techniques to improve processes and outcomes.
Demonstrated familiarity and ability to use Word & Excel and similar software products independently. - 6 Days Ago
Travel LTC Management DON (Director of Nursing) in Vancouver, WA - 684397
- Medical Solutions
-
Vancouver, WA
OTHER
- $3015.39-$3346.75 wk (includes wage of ~$35.84-$44.12/hr and per diems if eligible) click for benefits and other job details ~$1433.39-$1764.75 weekly taxable income ~$1582 in non-taxable per diem (am...
- 18 Days Ago
Director, Risk Management and Compliance
- Clinical Management Consultants
-
Port Angeles, WA
FULL_TIME
- An award winning hospital in the Washington North Peninsula area is in search of a new Risk and Compliance Director. This hospital has made a huge positive impact on the population it serves. It is kn...
- 24 Days Ago
Hospital Director Risk Management
- Clinical Management Consultants
-
Burbank, WA
FULL_TIME
- An exciting new opportunity has just become available for a Hospital Risk Management Director at an award winning hospital located in the southeastern part of Washington. Come join this dedicated team...
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Medical Social Worker Case Management
- Clinical Management Consultants
-
Forks, WA
FULL_TIME
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Interim Nurse Director Quality Management
- Clinical Management Consultants
-
Richland, WA
FULL_TIME
- An exciting opportunity is now available for an Interim Nurse Director Quality, Risk and Performance Improvement at an Eastern Washington Medical Center. The Interim Director Quality and Risk will rep...
- 2 Days Ago
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About Washington
Washington (/ˈwɒʃɪŋtən/), officially the State of Washington, is a state in the Pacific Northwest region of the United States. Washington is the northwestern-most state of the contiguous United States. It borders Idaho to the east, bounded mostly by the meridian running north from the confluence of the Snake River and Clearwater River (about 116°57' west), except for the southernmost section where the border follows the Snake River. Oregon is to the south, with the Columbia River forming the western part and the 46th parallel forming the eastern part of the Oregon-Washington border. To the wes...
Source: Wikipedia (as of 04/17/2019). Read more from Wikipedia
Income Estimation for Medical Management Director jobs
$166,534 to $223,020
Most Popular Cities in Washington for Medical Management Director Jobs
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