Senior Risk Management Specialist

Senior Risk Management Specialist

UPMC Corporate Legal is seeking a Senior Risk Management Specialist to join the team in Oakland, PA. This hybrid role offers a mix of onsite and remote work.

Reporting to the Senior Manager, Corporate Risk Management, the role involves systematically managing potential and actual claims. Analyzing clinical data is crucial for identifying liability areas, with corrective measures devised in collaboration with clinical teams. The focus lies on developing loss prevention initiatives in professional liability to enhance patient care quality and manage liability risks effectively. Critical thinking and strong leadership skills are essential, along with the ability to provide guidance and collaborate with UPMC leadership on project management.

If you have five years of experience within a clinical or healthcare setting along with a pharmacist or RN license, this could be the next step in your career. Apply today to join our team!

Responsibilities :

• Monitor occurrence-reporting system by analyzing and identifying trends and developing corrective action plans in conjunction with appropriate management and staff. Conduct high quality in-depth multi-disciplinary investigations of occurrences, which present significant risks in the area of professional liability and share information with appropriate management and staff. Review and evaluate potential and current claims with relevant internal departments and make appropriate recommendations to Senior Manager for approval or denial of requests for reimbursement or adjustments of claims. Establish files on potentially compensable events and submit to the Captive and Legal Services as appropriate. Participate in determining level of liability exposure and setting of reserves. Responsible for compliance with the provisions of the Safe Medical Device Act and providing the necessary support systems. Coordinate assigned professional liability legal suits with defense counsel. Open and maintain legal files, complete and update Case Summary Worksheets on all assigned cases. Gather information and requested documents to prepare draft Answers to Interrogatories, review Answers to Complaints and Interrogatories prior to Director's review and signature, schedule and attend meetings and depositions with hospital staff and defense counsel, attend trials and prepare written summaries for Director, review and present requests for settlement authority to Director.
• Evaluate informational requests from department heads and coordinate with the Information Systems Coordinator necessary parameters to meet the request and facilitate report preparation. Identify educational needs of the institution and develop specific educational programs for medical staff, nursing staff, allied health professional and others. Develop written material for distribution to hospital staff, office practices and affiliated programs both on and off campus and present onsite educational programs. Maintain awareness of current legislative activity affecting Risk Management by participating in local and national professional societies. Stay abreast of Risk Management trends by reviewing appropriate literature. Coordinate Risk Management functions with the multiple disciplines and other Risk Management Peers. Represent Risk Management on multi-disciplinary hospital committees and provide statistical information and reports as required or requested. Review and evaluate information from those committees for potential liability exposure. Seek appropriate corrective action plans from involved services and provide feedback to the committees. Develop, with the Patient Relations staff, a coordinated approach to patient and family complaints. Intervene at the request of UPMC Legal Services to provide information and guidance to staff regarding subpoenas and other legal matters. Coordinate access to information or staff with outside legal counsel and insurance investigators.
• Develop relationships within the management structure in order to facilitate investigation and feedback. Monitor occurrence reports, investigation, and resolution of significant events. Evaluate educational programs of UPMC Health System facilities and mobilize resources for developing specific programs to address the needs of the clinical and management staff. Establish a working relationship with staff of managed care organization and office site staff to facilitate integration of practice plans into the insurance program. Serve as liaison between the Risk Management and non-Faculty physicians. Identify specific needs of the hospital and / or office practices and develop Risk Management strategies to address those needs and act as resource for physicians and staff regarding medical legal issues. Act as a resource / consultant for staff and affiliates for questions and concerns regarding professional liability issues. Provide twenty-four-hour day coverage according to the department on-call schedule. Participate in Patient Safety Committees of designated areas.
• Bachelor of Science and five years clinical or healthcare experience.
• Experience in data / trend analysis and report preparation is necessary.
• Experience completing and facilitating root cause analyses and healthcare failure modes and effects analyses.
• This position requires an individual who is skilled in both verbal and written communication and demonstrates independence, leadership and the ability to make sound decisions.
• This position involves the handling of very sensitive and confidential information.
• Licensure, Certifications, and Clearances :
• Pharmacist OR Registered Nurse (RN)
• Act 34

UPMC is an Equal Opportunity Employer / Disability / Veteran