Registered Nurse- Clinical Risk Management

Job Summary

Under minimal supervision, the RN Clinical Risk Manager is responsible for the clinical review and analysis of significant occurrences as related to risk management, quality, and patient safety. This Risk Manager will be an integral part of the organization's Controlled Substance Diversion program.

Essential Functions:

• Review notice of claims, summons and complaints and perform a detailed claim investigation. Facilitate a thorough quality review of claims with either internal and/or external reviewers and present these findings to the Risk Management Committee for defense recommendations. (10%)

• Confer and work directly with claimants, attorneys, physicians, employees, and consultants involved in the claim. (10%)

• Act as a resource and liaison for individuals named in a notice of claim or summons and complaint. (5%)

• In collaboration with the Risk Management Director, determine whether the occurrence meets the elements for a state reportable event to Colorado Department of Public Health and Environment (CDPHE). (5%)

• Facilitate a thorough investigation of the occurrence via interviews, chart audits, video and supporting documentation and timely submit final findings to CDPHE along with proposed action items, if applicable. (10%)

• In conjunction with the Director, determine if significant occurrences meet the Joint Commission criteria for a sentinel event or near miss. In collaboration with the Patient Safety and Quality RN, thoroughly investigate the occurrence via interviews, chart audits, video and supporting documentation. Prepare and present the Root Cause Analysis (RCA) and proposed risk reduction strategies to the appropriate audience. May be called upon to participate in a disclosure meeting with the affected individual(s). (10%)

• Assist with monthly Controlled Substance usage reviews and audits: (5%)

• Review the monthly RxAuditor report and identify high users throughout the organization. Prepare monthly audit reports for managers or designated person to complete. (5%)

• Prepare monthly reports of audit results and findings, trend data. (10%)

• Assist with investigations and collaborate with leadership when suspected controlled substance diversion has occurred. Attend Diversion ad hoc meeting(s) and assist in reporting to law enforcement. (5%)

• Participate in Controlled Substance Diversion committee to include report preparation for meeting and assist where needed. (5%)

• Develop and expand current Controlled Substance Diversion program in collaboration with pharmacy. (5%)

• Act as a backup for the subpoena process and the Self-insured Workers Compensation program. (5%)

• Assist with CDPHE, Joint Commission and CMS surveys. (5%)

• Collaborate with Law Enforcement and Security when it appears a crime has been committed. (5%)

Education:

• Bachelor's of Science in Nursing Required

Work Experience:

• Three to five years of professional nursing experience in an acute care setting (Required)

Licenses:

• RN-Registered Nurse - DORA - Department of Regulatory Agencies Required

Knowledge, Skills and Abilities:

• Direct independent investigations of risk management matters, report results to stakeholders and assist in development of any necessary corrective action plan.

• Maintain a current working knowledge of federal and state laws and regulations concerning health care risk management.

• Demonstrate good judgment, strong analytical skills and excellent interpersonal and writing skills. Candidate must be highly self-motivated with the ability to function independently and as part of a team in a fast-paced environment with minimal supervision and direction.