Job Description
UNM Hospital
Albuquerque, New Mexico, Department: Risk Management FTE: 1. 00 Full Time (30 – 40 hours per week) Shift: Days Position Summary: Manages all aspects of clinical risk management including incident review and risk identification, conducting root cause analysis to develop process mapping and redesign, process improvement, action plans for data collection, measurement, policies, practices and training. Direct, plan, implement and monitor complex risk management investigations. Examine institution wide issues and prepare root cause analyses (RCA). Develop action plans, monitor milestone completion; audit compliance and analyze trends associated with clinical operations risks identified at the Health System. Ensure adherence to hospitals, departmental policies and procedures, and accreditation requirements. Provide clinical risk mitigation guidance, as needed, to providers, leaders and other hospital staff including the use of departmental rounding as an engagement tool; acts as a liaison with the Office of University Counsel and hospital staff for clinical risk issues. Provides a systematic and objective approach for the management and support of assigned initiatives and projects. Responsible for planning and overseeing clinical risk management projects that impact departments as well as organizational/systematic change. Promotes adherence to Hospital and Departmental Policies and Procedures.
No patient care assignment. Detailed responsibilities:
* RISK IDENTIFICATION – Conduct chart reviews and develop case summaries and timelines; review variance reports and investigate cases as appropriate; identify cases that meet TJC sentinel event criteria and other matrices utilized by the Risk Management department
* RESEARCH – Research standards of practice and best practices and recommend system redesign projects to reflect these standards and practices, in addition to accreditation requirements
* COMPLIANCE – In partnership with the quality department, assess the effectiveness of the action plan implementation and to ensure sustainability of system redesign
* LEADERSHIP – Plan, direct and manage programs and activities related to organizational and departmental clinical risk
* PLANNING – Consider, review and develop potential strategic clinical risk initiatives through root cause analysis (RCA) using RCA criteria and process improvement protocols to facilitate development and implementation of clinical risk strategic initiatives
* PLANNING â Manage the RCA planning process to include and validate strategic goals, identify and scope large scale initiatives and manage dependences between multiple projects
* RISK MANAGEMENT – Manage multiple complex risk management investigations, including the institution wide root cause analysis (RCA) process analyses and prepare root cause analyses (RCAs) to meet organizational needs; integrate with Health Sciences Center risk management
* RISK MANAGEMENT – Act as facilitator for assigned initiatives and create an environment for completion and success; Assure completion of RCAs, including action plans in concert with appropriate departments; track and trend RCA data
* RISK MANAGEMENT â Provide clinical risk management support to assigned departments as well as to multiple large scale projects; assemble project teams, provide definition and oversight for strategic initiatives with a focus on process improvement: plan document and track progress; provide guidance on project progress and completion
* RISK MANAGEMENT – Consult with RCA team members (clinical and business managers, senior management, medical staff leadership, front line and associated staff) to address causes of identified issues including: providing guidance for problem resolution, process improvement, team issues, resource requirements, risk assessment and mitigation and removal of barriers to successful project completion
* DEVELOPMENT – Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops such as the American Society for Healthcare Risk Managers (ASHRM) Qualifications Education: Essential:
* Bachelor’s Degree Nonessential:
* Master’s Degree Education specialization: Essential:
* Related Discipline Nonessential:
* Related Discipline Experience: Essential: 5 years directly related experience (hospital and/or clinical related experience preferably with supervisory or leadership role)Lead teams/individuals executing and managing changeManagement of multiple and changing priorities Nonessential: Credentials: Nonessential:
* RN in NM or as allowed by reciprocal agreement by NM
* American Society for Healthcare Risk Mgrs (ASHRM) Physical Conditions: Sedentary Work: Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. Working conditions: Essential:
* No or min hazard, physical risk, office environment
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