Consulting, Data Management, FDA (Food and Drug Administration), Healthcare, Healthcare Providers, Insurance, Interpersonal Skills, Legal, Medical Assistance, Medical Office, Negotiation Skills, Organizational Skills, Patient Assessment, Patient Care, Policy Development, Procedure Development, Process Development, Process Improvement, Quality Assurance, Risk Management, Standards of Care
Provide support and expertise both interdepartmental and system wide in areas of Risk Management, Professional and General Liability Claims Administration, and Data Management Support.
Qualifications:
Minimum Qualifications:
Education:
· Bachelor’s degree with 3 or more years of clinical healthcare experience or Master’s degree required
Licensure/Certification/Registry:
· Registered Nurse in the State of Illinois required.
Experience:
· Experience of working in a similar size and complexity of Memorial Health System
Other Knowledge/Skills/Abilities:
· Highly developed negotiation and interpersonal skills.
· Ability to work under limited supervision making decisions on non-routine issues and ability to provide solutions
· Moderate physical effort required
· Seldom travel
Responsibilities:
- Assess episodes of care to evaluate compliance with the Medical Practice Standard of Care.
- Engages in communication with healthcare providers and their patients to evaluate compliance with established processes, policies, and procedures.
- Recommend levels of appropriate compensation to claimants.
- Establish appropriate financial reserves to pay claimants for medical care, legal fees, and related costs.
- Works directly with MHS inside and outside legal counsel and insurance carriers to resolve all levels of claims.
- Acts as liaison between MHS and vendors when events occur. Provides details of events to be reported to the vendors and the Food and Drug Administration.
- Consults directly with the Quality Assurance and Medical Staff Office personnel to bring matters to their attention to improve processes and assist physicians in providing higher levels of care.
- Acts as daily consultant to all MHS staff and physicians in reference to risk control actions.