Job Description

The Manager of Risk and Regulatory Management is responsible for continual improvement in the quality, safety and satisfaction of care delivery, in their assigned facilities. Promotes and enhances patient safety in the facility and helps minimize loss by protecting the facility assets, administratively manages risk management day-to-day activities including; follow up incident investigation, RCA’s, potential adverse incidents, grievances, treatment issues or lost property; assists in claim investigation and maintains investigative and legal files; investigates medical staff related events and indications of care; resolves issues as appropriate; helps ensure compliance with risk management related statutes and other regulatory standards; initiates reports to Corporate Legal Counsel and regulatory agencies; and assists the Director of Quality and Performance Excellence.

Essential Functions:

• Reviews incident reports daily and investigates actual/potential, safety/liability issues.
• Coordinates investigation with appropriate director/manager.
• Maintains confidential documentation on investigation.
• Documents follow-up and solutions appropriately.
• Assists with reporting claim information on potential liability cases (PCEs) to Corporate Legal Counsel.
• Works collaboratively with Risk, Legal, Billing and Regulatory Compliance, Accreditation, and Regulatory Affairs leadership to comply with state and national norms of legal and regulatory health care compliance.
• Leads and leverages cross-functional teams to develop solutions through partnership with key business resources in the support of risk mitigation strategies, identification, quantification, and management of risks.
• Participate in hospital meetings and develop a collaborative relationship throughout the organization to leverage resources to advance risk prevention and claims and litigation/professional liability lessons-learned programs.
• Recommends appropriate revisions to new or existing policies, procedures, and forms to reduce the frequency of future occurrences; recommends ways to minimize risks through system changes; reviews and revises facility policies, bylaws, rules and regulations as appropriate to maintain adherence to current standards and requirements. Proactively coordinates and facilitates performance improvement teams to support key initiatives, including but not limited to, activities focused on clinical quality improvement, patient safety and risk reduction, patient experience, efficiency, FMEAS, and root cause analyses and medical staff improvement (e.g. OPPE, FPPE)
• Evaluates regulatory compliance concerns and makes recommendations for improvement to ensure that safety/regulatory recommendations are implemented in accordance with accreditation standards and guidelines.
• Ensures compliance with state and federal laws, government regulations, accreditation requirements, and Pipeline policies.
• Ensures internal control oversight and compliance with laws and regulations, safeguarding of assets, compliance with Pipeline policies and procedures, reliability of internal and external reporting, and efficiency and effectiveness of operations.
• Creates an effective control environment, conducts risk assessment, implements, and monitors controls.
• Remains informed regarding emerging threats to ensure that risks are well known and understood.
• Facilitates investigations and management of timely submissions of patient and health plan grievances.
• In concert with the System Manager of Clinical Quality and Data Analytics management of FMEA process and implementations.
• Serves as the subject matter expert for federal, state, and local regulations by providing consultation on the interpretation, interaction, and implementation of current policies, regulations, and advice on the current climate and potential changes which may have long term effects on hospital operations and patient care.
• Champion development of and evaluating educational programs to align organizational policies and procedures with regulatory requirements; and removing barriers to process improvements issues, informing, and escalating barriers to senior leaders as appropriate, and weighing practical, technical, and Pipeline capability considerations in addressing issues and advice on policy changes.
• Serves as the liaison between applicable government, regulatory, and key stakeholders and conducts facilitation of on-site visits and evaluations.
• In concert with the QRM Director and local hospital leadership and executives, establishes expectations organization-wide to ensure survey readiness.
• Plans for highly impactful development, evaluations, and delivery of educational programs.
• Conducts routine audits and mock surveys to aid in preparedness, tracking, trending, and facilitation of corrective action plans.
• Collaborates with others to complete annual reporting and evaluations.
• Ensures licensing and accreditation by championing and maintaining the importance for requirements for new, expanding, and existing facilities/services in relation to relevant accrediting standards, evaluating relevant risk and impact.
• Champions collaborative efforts to ensure certification and evaluates gap analyses.

Behavioral Standards:

• Strong understanding of risk management, patient safety, and regulatory principles and practices.
• Participates and provides leadership in concert with the Director of Quality and Performance Excellence, Infection Prevention with regulatory readiness and survey preparation activities including mock survey tracers.
• Provides support and assistance to medical staff officers, committee chairpersons and Governing Body, as required.
• Utilizes information obtained via performance improvement activities to seek and act on opportunities to improve patient care processes.
• Ability to identify and assess potential risks to patient safety.
• Demonstrates the highest level of professionalism, passion and care when interacting with patients, families, physicians, and hospital staff members.
• Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential, embracing ingenuity to service our customers.

Communication/Knowledge:

• Maintains open lines of communication with all hospital departments.
• Demonstrates effectiveness in planning and implementing the performance improvement program to meet the needs of the hospital.
• Demonstrates knowledge of current performance improvement methodology and practices. Maintains awareness of changes in the regulations and requirements by accrediting bodies.
• Demonstrates use of database systems to document occurrences, medical staff review functions, committee review and actions. Compiling reports for committees, Governing Board and administrative team.
• Consults with other departments as appropriate to collaborate in patient care and performance improvement activities.
• Maintains current knowledge of accreditation and licensing requirements and must be a resource to staff on these regulations to improve management of outcomes and ensure compliance.

Collaboration/Teamwork:

• Maintains an environment of collaboration and cooperation among hospital departments.
• Contributes toward effective, positive working relationships with internal and external colleagues.
• Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization.

Qualification/Experience:

• Minimum of five (5) years of experience in risk management, patient safety, and regulatory management, with at least three (3) years of experience in a leadership role.
• Critical thinking, service excellence and good interpersonal communication skills, ability to read/comprehend written instructions, strong organizational skills, ability to follow verbal instructions, and PC (computer) skills.
• A capacity to learn, synthesize, make critical judgments, work independently, place patients and families first, and collaborate with the team members who are recognized leaders within health care.

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