Risk Management Specialist

Location: San Antonio, TX
Date Posted: 02-19-2018
Risk Management Specialist
About Us:
Fidelity Partners is a leading national healthcare support services company specializing in the Medical Staffing, Executive Search, and Outplacement of medical professionals for both premier private sector clients and in support of our military and government clients. We are committed to the highest levels of professional and ethical service in the market today and work to cultivate long-term relationships. We have a reputation built on integrity, an expert knowledge of the medical industry and attention to individual client and employee needs. 
We are currently accepting qualified applications for a Risk Management Specialist to support one of our Government clients in beautiful San Antonio, TX.
  • Review/route medical files/documents in accordance with Department of Defense Directive 6000.6 Medical Malpractice Claims Against Military and Civilian Personnel of the Armed Forces and AFI 41¬210, Tricare Operations and Patient Administration Functions, paragraphs 4.5.3., 5.8.7., 5.8.8., & 5.8.9. pertaining to the malpractice claims process. Research and gather essential medical data for responding to Inspector General (IG) complaints, Congressional Inquiries, and Wing Patient Advocate responses.
  • Advise and assist the clinical leadership, the medical and nursing staff, and other paraprofessional and administrative healthcare staff in developing responses to allegations of medical malpractice.
  • Work in cooperation with the Medical Legal Counsel and Air Force Medical Operations Risk Management for ongoing review and closure of all medical malpractice claims and litigation.
  • Use critical thinking skills to prompt and participate in the investigation of medical malpractice claims, Potential Compensatory Events (PCE); Sentinel Events (SE) and Medical Incident Investigation (MII).
  • Ensure a Quality of Care review (QOC) with standard of care (SOC) determination is made for all significantly involved providers of care.
  • Coordinate all QOC reviews with the appropriate medical departments for specialty reviews and return all documentation to the Director, Risk Management upon completion for the final review process.
  • Coordinate, assemble, and manage risk management case files. Create claims files and gather clinical records for QOC reviews. Ensure the original medical record is sequestered.
  • Maintain a certified copy (hardcopy and/or e-copy) of any/all required outpatient, Urgent Care Center (UCC) and same day surgery medical records, diagnostic studies (to include but not limited to: radiograms, laboratory studies, pathology, autopsy reports), and external healthcare records if/when needed.
  • Retrieve, as needed, information from Composite Health Care System (CHCS), AHLTA, ESSENTRIS (inpatient EMR), or Integrated Clinical Database (ICDB) dictation or narrative summaries.
  • Process and enter all Standard Form (SF) 95, Medical Malpractice claims requests received from the Air Force Legal Operations Agency/Tort Litigation Division (AFLOA/JACC) Office into the Risk Management claims module in the Centralized Credentials Quality Assurance System (CCQAS) secure database.
  • All QOC reviews will be entered into CCQAS within the suspense of 90 days from receipt of the SF 95.
  • Prepare official certified mail to notify significantly involved providers in medical malpractice claims; QOC/SOC review results.
  • Coordinate provider's Memorandum for Record (MFR), rebuttal MFR, and references, staying within the guidelines of the Department of Defense and Air Force Policy for healthcare risk management activities.
  • Forward all the MTF level QOC reviews and documents to the AFLOA/JACC Office for further investigation and provide additional documentation support if necessary.
  • Update all CCQAS entries on each malpractice claim and enter Significantly Involved Providers (SIP) determinations and claim assessments from the MTF and Expert Level QOC reviews.
  • Send out the second letter of notification and release the CCQAS malpractice claim to the Air Force Medical Operating Agency/Risk Management Operations Office (AFMOA/SGHQ) for final review, litigation and SOC determination.
  • Contact the AFLOA/JACC Office for monthly and quarterly qualitative and quantitative Risk Management analysis on malpractice claims for the Executive Committee of the Medical Staff (ECOMS).
  • Independently perform statistical analysis of outstanding malpractice claims, PCEs, SEs, and MIIs.
  • Maintain a list of all sequestered medical records secured in the Release of Health Information Office on all malpractice claims and PCEs. Maintain a log of all correspondence sent out by certified mail or Federal Express.
  • Send out final letters of notification by certified mail to all privileged and non-privileged providers with the final SOC determination.
  • Manage the Risk Management (RM) spreadsheet of all QOC reviews out for specialty review, pending QOC reviews to be reviewed by the RMF.
  • Forward all verification requests for provider information on medical malpractice claim history or adverse privilege/practice actions (clinical and administrative-HIPDB) to AFMOA/SGHQ, Chief, Risk Management Operations.
  • Prepare PowerPoint slides to present current RM information (Lessons Learned, claims management's status updates, etc) for the Risk Management Function (RMF).
  • Assist with managing the audio-visual presentations from the secure drive on all QOC reviews and SIP determinations for review by the RMF.
  • Provide some administrative support for activities within the Risk Management Program to include medical malpractice/litigation claim processes, PCEs, and clinical and nonclinical adverse actions.
Additional Qualifications:
  • Have a minimum of 2 years of experience within the last 48 months in Healthcare Risk Management.
Interested candidates may apply at careers@fidelitypartners.org or fax resumes to 210-568-4518.
Thank you for providing us your candidacy request we will review your background and qualifications to determine a potential match for this opportunity, if we determine you are a good fit one of our executive recruiters will contact you as soon as possible to discuss next steps, if you are not we will retain your information in our database for future opportunity.

Kindest Regards,
Fidelity Partners
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