Claims and Litigation Specialist - Risk Manager
SFSFH-Hospital Administration Job Summary This position requires onsite work 2 days per week and additional days as needed.
Functions as a lead and resource on cases of high complexity. Applies extensive knowledge of industry practices in health care risk management and advanced professional concepts to substantial projects, typically at high degrees of complexity. Counsels senior managers on major risk factors and processes to prevent risk and liability. Regularly serves on committees.
This position supports the activities of UCSF Health in support of the Mission, Vision and Values of the organization, promotes high-quality patient care, compliance with UCSF Medical Center policies, patient safety, and patient and family services. This position works independently and in collaboration with other Risk Management Staff, medical center staff, and physician leaders, developing close, strategic, and collaborative relationships across the institution.
Along with department leadership, this position handles professional liability claim management for all of UCSF Health, inclusive of UCSF Medical Center, LPPH, ambulatory practices, and the School of Dentistry. This position engages in every aspect of claims/litigation handling, from the initial intake and claim submission through resolution and corrective action planning. This position works independently and collaboratively with departmental leadership, as well as with the third-party claims administrator and outside counsel, to investigate the claim, research and respond to discovery requests, and trial preparation. The Claims and Litigation Specialist Risk Manager is a primary point of contact for cases in active litigation and ensures that claims are reviewed at internal risk management committee meetings and that appropriate risk mitigation prevention opportunities are timely identified for implementation. The Risk Manager is also responsible for keeping departmental leadership apprised of litigation activities, as well as ensuring that the claims database is updated with claim developments.
In addition to handling professional liability claims, this position also provides risk advice in a variety of areas, including consent, mandatory reporting, patient/family/visitor behavior, threat management, medication management, adverse event management, patient complaints and grievances, Medical and Nursing Board complaints, privacy and confidentiality, surgical complications, disclosure of adverse events, discharge and discontinuation of care, elopement and AMA, media requests, policies, and procedure, to name a few.
This position will develop and demonstrate knowledge of professional liability standards of care as well as regulatory standards inclusive of Joint Commission, Medicare Conditions of Participation, Title 22 and other California Laws and Regulations. The final salary and offer components are subject to additional approvals based on UC policy. Your placement within the salary range is dependent on a number of factors including your work experience and internal equity within this position classification at UCSF. For positions that are represented by a labor union, placement within the salary range will be guided by the rules in the collective bargaining agreement. The salary range for this position is $150,000 - $180,000 (Annual Rate). To learn more about the benefits of working at UCSF, including total compensation, please visit: https://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html Department Description The primary function of the Risk Management Department is to minimize financial exposure to UCSF Health (inclusive of UCSF Medical Center, UCSF Benioff Children's Hospitals, UCSF School of Medicine, Nursing, Dentistry and Pharmacy, LPPH, and UCSF affiliates) arising from professional liability matters. The department also serves as a resource to all UCSF Health employees regarding risk management issues. Risk management consultation is provided on a 24-hour basis. The department is located at 1800 Owens Street, 4th Floor. Required Qualifications
- Bachelor's degree in a related area and / or equivalent experience/training.
- Minimum five years experience in large hospital risk management, quality management or claims management program, or comparable work experience
- Knowledge of healthcare risk management issues and ability to apply knowledge and skills to provide advice. Ability to apply knowledge and skills to recommend improvements to risk management processes and procedures.
- Advanced knowledge of claims and litigation handling.
- In-depth knowledge of relevant risk management industry and medical malpractice federal, state, and local laws and regulations.
- Advanced analytical and critical thinking skills to identify potential significant risks. Ability to consistently produce high-quality, thorough work despite pressing deadlines by accurately completing activities the first time. Knowledge to check for quality and correct own errors.
- Time management skills to prioritize personal and team tasks and see projects through from inception to completion on schedule. Demonstrates adaptability and flexibility to effectively handle change.
- Interpersonal skills to work collaboratively, coordinate, and integrate with others throughout the organization and with outside counsel, claims people, and UCOP Skills that include diplomacy, discretion, and tolerance and the ability to respond in stressful or time-sensitive situations.
- Advanced analytical abilities and problem-solving skills to quickly evaluate complex issues, identify options for resolution, and apply sound judgment.
- Strong verbal and written communication skills to effectively communicate through all mediums and with all groups. Ability to listen actively, understand varying viewpoints, and receive feedback.
- Ability to perform all commonly applicable functions in word processing and spreadsheet software. Strong computer skills, including Microsoft Word, Excel
- Proven ability to maintain confidentiality of sensitive information. Discretion, tact, and ability to deal with sensitive issues.
Preferred Qualifications
- Advanced knowledge in healthcare risk management theory and industry best practices
- Ability to apply knowledge and skills to recommend improvements to risk management processes and procedures and claims administration.
- Juris Doctorate degree
- Paralegal
- Certified Professionals in Health Care Risk Management (CPHRM)
About UCSF At UCSF Health, our mission of innovative patient care, advanced technology and pioneering research is redefining what's possible for the patients we serve - a promise we share with the professionals who make up our team.
Consistently ranked among the top 10 hospitals nationwide by U.S. News & World Report - UCSF Health is committed to providing the most rewarding work experience while delivering the best care available anywhere. In an environment that allows for continuous learning and opportunities for professional growth, UCSF Health offers the ideal atmosphere in which to best use your skills and talents. Pride Values UCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity and excellence - also known as our PRIDE values.
In addition to our PRIDE values, UCSF is committed to equity - both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available at diversity.ucsf.edu
Join us to find a rewarding career contributing to improving healthcare worldwide. Equal Employment Opportunity The University of California San Francisco is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Job Code and Payroll Title 005804 RISK MGT HC PROFL 4 Job Category Professional (Non-Clinical), Professional and Managerial Bargaining Unit 99 - Policy-Covered (No Bargaining Unit) Location San Francisco, CA Additional Shift Details Monday - Friday |
University of California - San Francisco Campus and Health
Jan 07, 2025