Career Center

Job Summary

The Director of Claims & Clinical Risk Management directs and supervises two major functions within the Office of Risk and Insurance Management (ORIM): (1) clinical risk management and (2) management of the following types of claims: professional liability, general liability, workers' compensation, auto liability, and property damage. Supervises staff that includes clinical risk managers, data analyst, and program manager to carry out the functions. Works with staff throughout the organization, from senior leaders to front-line staff, to promote risk management, patient and worker safety, and quality improvement. Plays a key role in managing self-insurance funds through reserving, monitoring expenditures, assessing risk exposure, and making recommendations for resolution.

Department Summary:

The Office of Risk and Insurance Management exists to support the Medical Center's missions of research, education, and the delivery of excellent patient care through a combination of risk financing, risk prevention, and risk control activities. Our goal is to provide excellent, ethical and timely risk management resources and services to our internal and external customers. We reach these goals by:

• Treating others professionally and with respect;
• Taking responsibility for finding a solution to any problem or complaint for all those seeking our services; and
• Continuously evaluating and improving our performance.

Position Shift: 1st shift; Days (Hybrid)

Discover Vanderbilt University Medical Center:

Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded and your abilities challenged. It is a place where your diversity -- of culture, thinking, learning and leading -- is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt's mission is to advance health and wellness through preeminent programs in patient care, education, and research.

VUMC Recent Accomplishments

Because we are committed to providing the best in patient care, education and research, we are proud of our recent accomplishments:

* US News & World Report: #1 Adult Hospital in Tennessee and metropolitan Nashville, named to the Best Hospitals Honor Roll of the top 20 adult hospitals, 10 nationally ranked adult specialty programs, with 3 specialties rated in the top 10 nationally, Monroe Carell Jr. Children's Hospital at Vanderbilt named as one of the Best Children's Hospital in the nation, with 10 out of 10 pediatric specialties nationally ranked.

* Healthcare's Most Wired: Among the nation's 100 "most-wired" hospitals and health systems for its efforts in innovative medical technology.

* Becker's Hospital Review: named as one of the "100 Great Hospitals in America", in the roster of 100 Hospitals and Health Systems with Great Oncology Programs and to its list of the 100 Hospitals with Great Heart Programs.

* The Leapfrog Group: One of only 10 children's hospitals in the to be named at Leapfrog Top Hospital.

* American Association for the Advancement of Science: The School of Medicine has 112 elected fellows

* Magnet Recognition Program: Received our third consecutive Magnet designations.

* National Academy of Medicine: 22 members, elected by their peers in recognition of outstanding achievement

* Human Rights Campaign Healthcare Equality Index: 6^th year in a row that Vanderbilt University Medical Center was a Leader in LGBTQ Healthcare Equality.

Key Functions and Expected Performance:

Clinical Risk Management

1. Provides advanced level management and analysis of risk management data:
   1. Oversees accurate and thorough data entry for VUMC's event reporting system (VERITAS) and claims database for reporting purposes;
   2. Identifies and analyzes trends in VERITAS and claim data to recommend prioritization of institutional patient safety initiatives;
   3. Shares claim and VERITAS data with senior and mid-level leadership;
   4. Oversees VERITAS infrastructure and reporting.
2. 2. Creates and delivers or supervises educational programs for faculty and staff related to patient safety and risk management.
3. 3. Provides risk management expertise for policy development.
4. 4. Advises departments, interdisciplinary teams, and work groups on risk management principles and strategies.
5. 5. Serves as the risk management representative on multiple committees to provide advice and direction to improve patient safety and reduce risk, including but not limited to those involving Quality, Pharmacy, Nursing, Documentation, and Safety.
6. 6. Manages and oversees reporting of patient safety and risk management issues to governmental agencies such as CMS, FDA, and the TN Department of Health to comply with state and federal laws, rules, and regulations.
7. 7. Serves as risk management liaison with the recall coordinator related to product recalls, including recommendations for management and internal and external communications. Oversees any required external reporting.
8. 8. Oversees and supervises requests for explants and surgical pathology specimens.
9. 1. Assists with presentations and communications with excess insurance carriers as appropriate.

Claim Management

1. Professional and General Liability Claims
   1. Supervises or directly performs primary intake and evaluation of patient events.
   2. Screens and evaluates reports to risk management by clinical faculty and staff through phone calls and VERITAS.
   3. Serves as an on-call resource advising clinical faculty, staff, and administrators regarding management of acute patient events.
   4. Evaluates events and claims including investigation, interviews, analysis of medical records, policies and procedures, equipment, and expert opinions.
   5. Recommends management and resolution of events, including an analysis of the standard of care, causation, damages, and establishment of a monetary reserve and regular reports to the self-insurance Trust Committee.
   6. Advises clinical faculty and staff regarding disclosure of adverse patient events.
   7. Coordinates communication and planning with internal and external counsel for high-risk events.
   8. Assigns defense counsel as appropriate, and manages litigation including recommendations for resolution or trial.
   9. Ensures proper and timely reporting to the insurance carriers, as appropriate.
   10. Negotiates settlements with patients, families, and plaintiff attorneys, including participation in mediations, as appropriate.
   11. Supervises other clinical risk managers in above activities.
2. 2. Workers Compensation
      1. Supervises staff in all aspects of workers' compensation claim management:
         1. Reporting process;
         2. Review, investigation, and determination of compensability;
         3. Establishment of reserves and payment of benefits;
         4. Settlements;
         5. Assignment and oversight of defense counsel;
         6. Proper documentation and compliance with state reporting requirements;
         7. Reporting to the excess insurance carrier as appropriate;
         8. OSHA and record-keeping.
      2. Identifying and monitoring trends in injuries.
      3. Communicating with managers and senior leaders about trends and individual claim issues.
      4. Participating and supporting committee work to reduce employee injuries, such as Safety, Ergonomics, OSHA, and Workplace Violence.

Property and Automobile Claims

1. Supervises proper intake and documentation of claims, including reporting to the insurance carrier as appropriate;
2. Supervises determination of compensability of property claims;
3. Supervises management of large property claims, including working with the insurance carrier and their claim adjuster;
4. Ensures proper and timely reporting of auto liability claims to the insurance carrier.