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Overview

Senior Risk Manager and Regulatory Specialist, Quality Managment

Full Time, 80 Hours Per Pay Period, Day Shifts

Cumberland Medical Center Overview:

Cumberland Medical Centerin Crossville, Tennessee is part of Covenant Health, East Tennessee’s largest nonprofit health system and a Becker’s “Top 150 Places to Work in Healthcare.” Fully accredited by the Joint Commission, Cumberland Medical Center is an acute care hospital offering all private patient rooms as well as comprehensive care including cardiology, orthopedics, maternity, cancer treatment, and wound care. The hospital features emergency and critical care, surgical suites, and specialized programs such as imaging, cardiac rehab, sleep disorder care, and hyperbaric medicine, all in a family-oriented environment focused on exceptional patient care.

Position Summary:

The Sr. Risk Manager and Regulatory Specialist position is responsible for planning, budgeting, monitoring, and evaluating performance related to the Joint Commission, CMS, and other regulatory/licensing agencies. Responsible for maintaining current knowledge of all applicable regulations and providing regular educational updates on new and problematic standards to leadership, the facility regulatory specialists, and applicable stakeholders. Coordinates the maintenance of the CIHQ contract and Joint Commission Resource Tools. Provides guidance to leaders for how to best utilize mock surveys and readiness resources such as audit tools, etc. Responsible for timely submission of updates for the Joint Commission application for triennial surveys and certification surveys. Responsible for organizing and supporting ongoing regulatory compliance and for supporting a regulatory compliance committee. The leader of regulatory specialist is responsible for organizing, composing, and following up on all regulatory compliance findings including state surveys, e.g., EMTALA. Actively participates in system activities to support shared learning and regulatory compliance throughout the Health System. The regulatory specialist is directly responsible for managing all onsite survey activities including, but not limited to: Joint Commission, CIHQ, state surveys, and other regulatory agencies.

The Sr. Risk Manager and Regulatory Specialist is also responsible for the facility’s risk management activities, which include, but may not be limited to, managing claims against the facility, interfacing with defense legal counsel, administering the risk management program on a day-to-day basis, managing and analyzing risk management data, conducting risk management educational programs, complying with risk management related standards by the Joint Commission and other accrediting or regulatory agencies, all with the objective of maintaining patient safety, enhancing quality care, and minimizing loss to protect the assets of the facility. This individual participates in formulating policy and/or organizational changes.

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Responsibilities

+ Provides direction and support to organizational leaders and staff in all areas of regulatory compliance through training, review, summarization, and dissemination of all updates.

+ Develops and implements action plans to support regulatory compliance in collaboration with leaders from: Nursing, Information Systems, Infection Prevention, Facility Management, and Facility Senior Leader Teams, etc.

+ Serves on the System Policy and Procedure Committee to ensure policies comply with regulatory/licensing standards.

+ Develops and implements educational programs to ensure successful completion of survey visits.

+ Implements processes and audits to ensure facility remains in a state of continuous readiness.

+ Keeps leadership appraised of new and/or problematic standards as well as any issues identified at the local level.

+ Ensures the completion of an FMEA at the facility level to meet regulatory requirements.

+ Directs the activity related to yearly focused standards review.

+ Determines schedules and oversees completion of tracer activities and mock surveys on a regular basis.

+ Works in collaboration with Regulatory Specialist for Engineering and Human Resources, site Safety Teams, Infection Prevention Teams, Medical Staff Office, and Environment of Care Teams to ensure coordination or continuous survey readiness through regulatory compliance.

+ Works directly with the Corporate Quality and Patient Safety leadership to ensure system safety and reliability.

+ Collaborates with and reports all survey functions, findings, and action plans to the corporate Quality and Patient Safety department and other applicable corporate departments.

+ Represents the facility onsite during any Joint Commission, CMS, or State visits.

+ Participates as a member of the Quality and Care Management Team in project and budget planning.

+ Has full responsibility for operations of the risk management program at the facility.

+ Directs loss control/loss prevention activities and reports results to senior administration at the facility and the corporate risk department.

+ Supervises the statistical trending of losses and analyzes patterns.

+ Designs and implements risk management surveys and studies; conducts surveys, studies, and special projects to assist in long-term planning and changes to facility policies and systems that reduce risk and losses.

+ Responsible for identifying and communicating regulatory requirements.

+ Leads development of facility-wide approach on disclosure of medical errors and obtains physician support.

+ Submits recommendations for changes in the existing risk control and risk-financing procedures based on changes in properties, operations, or activities.

+ Evaluates correspondence from attorneys, patients, and other outside sources, and formulates responses, as necessary.

+ Records, collects, documents, maintains, and communicates to corporate risk and/or attorney any information necessary to prepare testimony in pending litigation.

+ Assists with release of records and information in response to subpoenas, court orders, attorney requests, state and federal agency investigations, and other inquiries from outside sources.

+ Maintains risk case files and strives to maintain maximum protection from discoverability of such files.

+ Answers medical/legal inquiries of physicians, nurses, and administrators regarding emergent patient care issues and loss control.

+ Resolves treatment issues, including patient decisions made against medical advice (AMA), refusals of treatment, and consent issues; initiates court orders as appropriate via in-house and outside legal counsel.

+ Maintains awareness of legislative activities that may affect risk management programs and participates in the legislative process.

+ Leads and/or participates in the Risk Management Subcommittee, affiliate Risk Management Subcommittee, Root Cause Analysis Oversight Team, Patient Safety Committee, and others as directed.

+ Receives incident reports and other information regarding untoward occurrences in the facility, and collates such information systematically to permit analysis pursuant to risk management policy and procedure. When risk management personnel are informed of an incident, the investigation should include getting the facts, determining the event’s significance, reviewing the medical record, deciding who must know about the event, determining how to proceed with the patient, securing all evidence (e.g., documentation, equipment, etc.), interviewing appropriate people, and creating a comprehensive investigation file.

+ Plans, develops, and presents educational material to administration, the medical staff, nursing personnel, and other department personnel on topics related to risk management as they affect personnel.

+ Supports the patient safety initiatives through direct participation on committees/task forces.

+ Develops and implements educational programs designed to minimize the frequency and reduce the severity of actual and potential safety hazards throughout the facility.

+ Leads root cause analysis and makes recommendations for improvement.

+ Active participation in patient safety goals by providing data to support priorities.

+ Acts as resource, internal consultant, and educator for patient safety/risk management issues.

+ Responds to professional liability and facility liability questions posed by physicians, nurses, and other personnel.

+ Complies with various codes, laws, rules, and regulations concerning patient care, including those mandated by state and federal agencies; incident reporting; and investigative activities with federal, state and local enforcement authorities.

+ Disseminates lessons learned from root cause analysis, system, or process failures and the results of proactive risk assessments to staff that provide services for the specific situations. Disseminates feedback to the appropriate providers and workforce.

+ Assists in communicating unanticipated outcomes and/or unusual events to patients and their families in a compassionate and honest manner and in compliance with our policies and procedures.

+ Oversees investigation of incidents, accidents, and events that could lead to financial loss, including professional liability, general liability, and workers’ compensation.

+ Investigates risks involving actual or potential injury to patients, visitors, and employees; collects information necessary to prepare for the defense of claims.

+ Interacts with legal counsel and patients/families to effect timely settlement.

+ Provides direction and advice to medical staff, as necessary, in connection with malpractice litigation and medicolegal matters.

+ Reports patient care-related incidents to the Department of Health, FDA, or other agencies if required by law; directs investigation and development of corrective plans; submits required reports to state and federal agencies.

+ Complies with required mandatory reporting of the Medicare, Medicaid, and SCHIP Extension Act of 2007.

+ Plans, develops and presents educational material to administration, medical staff, nursing personnel, and other department personnel on current topics related to risk management.

+ Develops and implements educational programs to reduce or eliminate potential safety hazards throughout the facility.

+ Develops and presents educational material to new and current employees.

+ Local travel required.

+ Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.

+ Performs other duties as assigned.

Qualifications

Minimum Education:

Bachelor’s Degree in Nursing or Associate’s Degree in Nursing with two (2) years of experience in a quality. Master’s Degree preferred.

Minimum Experience:

Five (5) years of experience in a hospital setting. Able to demonstrate a working knowledge of Joint Commission Standards and Medicare Conditions of Participation.

Licensure Requirement:

Registered Nurse licensed in the state of Tennessee. Employee must have a valid Tennessee driver’s license and state mandated minimum insurance coverage. Driving record must meet Covenant Health minimum standards at the date of hire and throughout employment tenure.

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Job Title SR RISK MGR & REGULATORY SPECI

ID 4429895

Facility Cumberland Medical Center

Department Name QUALITY MANAGEMENT