Sutter Health | Palo Alto Medical Foundation - Mountain View
February 13, 2018
Mountain View, California
Full Time - Experienced
The CRO is responsible for the development and maintenance of the overall risk management program for PAFMG, with the overall goal of identifying and mitigating risk to the Organization. The CRO is responsible for the day-to-day operations of Capstone Insurance, LLC., and communication and coordination with Capstone's board of Directors and service providers. The CRO directs the strategic development and maintenance of the risk financing portfolio for the PAFMG enterprise, management of all claims and litigation involving PAFMG, and serves as an advisor to senior leadership on mitigation of risk by participation on various committees throughout PAMF and PAFMG. In addition, the CRO is responsible for the development and coordination of an integrated clinical risk management program for PAFMG, including identification and coordination of clinical loss prevention initiatives and comprehensive loss prevention education program across PAFMG. The CRO ensures compliance with applicable state and federal statutes and regulations and with accreditation standards for safety and risk management.
Responsible for the day-to-day operations of Capstone Insurance and communication and coordination with Capstone's board of Directors and service providers. Facilitates and/or attends all meetings related to Capstone's business or operations.
Directs the claims and litigation program for PAFMG for all lines of coverage.
Responsibilities include ensuring the timely reporting of claims, setting and monitoring of reserves, directing legal counsel and third party claim administrators and defense strategies, obtaining settlement authority from senior leadership, maintaining appropriate file documentation and serving as a liaison with insurers on specific claims. Monitors payment of fees for defense counsel and payment of claims defense expenses. Approves payment of legal fees related to non-covered expenses, such as third party legal requests. At times, serves as corporate representative in the course of litigation against PAMFMG.
Directs all aspects of insurance management for PAFMG including development if risk financing strategy for all lines of coverage, collection of data and information for insurance renewals and actuarial analysis for self insured retentions, and serves as a liaison with insurance brokers, consultants, underwriters and actuaries.
Provides regular reports to senior leadership regarding risk financing, claims and litigation, and general risk management matters.
Collects, evaluates and maintains aggregate enterprise-wide data for reporting to senior leadership. Develops and implements systems, policies and procedures for identification, collection and analysis of risk management information, including maintenance of centralized database of risk management information and aggregation of data.
Participates in clinical, operational and administrative committees to provide advice on risk mitigation. Facilitates and/or chairs regular meetings of the PAMF/PAFMG Joint Risk management Committee meetings including agenda development, action plans and follow-up reports from members. Establishes or attends other committee meetings as needed to ensure timely reporting of risk management information to senior leadership.
In coordination with the PAMF Risk Officer, develops and supervises the clinical and non-clinical risk management program for PAFMG to include identification and develop loss control initiatives and a comprehensive risk education program.
Directs and supervises claims (loss) history process, requests for certificates of insurance, evaluates and approves other requests for insurance coverage for PAFMG providers.
Advises on management of risk and required insurance levels in contracts, agreements, leases and other legal documents.
Actively communicates with involved health care providers on the on the status of a claim and potential malpractice/professional liability reporting obligations and answers questions as needed. Ensures compliance with regulatory requirements regarding malpractice reporting to the NPDB and California Medical Board my making timely reports and notifying involved providers. Reviews with Foundations CEO cases that may result in major settlements or adverse verdicts.
Perform other duties as assigned.
Required: Bachelor's health care administration related; Doctorate of Jurisprudence Attorney - ATT-JD,
Certified Professional in Healthcare Risk Management - CPHRM preferred.
Experience in healthcare risk management and/or claims management.
Working within a complex ambulatory setting and physician driven organization
Proven record working successfully with groups to achieve desired outcome. Understanding of project management and project teams is essential.
Ability to communicate in a clear, confident, and concise manner both verbally and in written form is essential.
Strong problem-solving and interpersonal skills; must be able to work independently as well as collaboratively within all levels of the Organization, including physicians, employees and management staff.
The ability to protect confidential information; understanding when and to whom has a specific business need to have information shared.
Experience with collection, analysis and reporting of data of quantitative methods.
Ability to prioritize, manage multiple tasks and reporting within matrix relationships
Knowledge of state and federal legal and regulatory requirements.