JOB DESCRIPTION FOR JOB TITLE:



|POSITION SPECIFICS |

|Title: Risk Management Specialist |Department/Number: Risk Management, 1003 |

|Reports to: Director, Risk Management | |

|Job Code: 310008 |FLSA Status: Non-Exempt | |

|Manager Approval: D Ankowicz Date: 1-17 |HR Approval: CMW 1-17 |

|POSITION SUMMARY |

|The Risk Management Specialist is responsible for coordination and management of a variety of risk management processes within the UW Health Risk Management |

|Department, assisting the Director and Sr. Risk Management Consultant(s) in risk identification and mitigation activities, including educational programing |

|designed to promote patient safety and proactively reduce the occurrence of medical errors, patient complaints, decrease the frequency and severity of |

|claims/lawsuits and improve the defensibility of claims/lawsuits when filed against the UW Health and its employees. Types of claims may include, but are not |

|limited to, D&O, professional, general, automobile, property and other liability claims. The incumbent also assists with the maintenance of resulting claims |

|data, including insurance coverage and claims information for medical staff credentialing purposes and coordination and tracking of risk management educational|

|programming, as required by the medical staff bylaws and core competencies for graduate medical education. |

| |

|The incumbent assists Director with insurance program management, including driver approvals, completion of renewal applications, communication with insurance |

|broker to obtain certificates of insurance (COI), claim reporting to insurance carriers and processing of broker/insurance company invoices. The incumbent |

|communicates and collaborates with RM colleagues; insurance company claims representatives, broker consultants, University of Wisconsin (UW) System and UW |

|Campus Risk Management, the UW Madison Office of Legal Affairs, UW-Madison Risk Management Manager and others, as necessary, to prepare responses to legal |

|pleadings and to bring claims to closure. |

| |

|The incumbent works primarily independently with general supervision from the Department Director for policy clarification and initial direction regarding new |

|initiatives. The incumbent collaborates with a variety of organizational personnel, including, but not limited to, Valet Manager to manage auto claims and |

|Patient Relations staff on potential liability issues as it pertains to reimbursement requests for lost or damaged patient belongings and dental injuries. |

| |

|The incumbent assists with medical device reporting to MedSun, as required by the Safe Medical Devices Act as well as with general departmental processes |

|designed to identify, manage, and reduce organizational risks. Utmost discretion in all verbal and written communication is required. |

|MAJOR RESPONSIBILITIES |

|A. CONDUCTS INVESTIGATIONS AND ANALYSIS OF LIABILITY AND OTHER CLAIMS. |

|On behalf of and in collaboration with internal and external claims mangers and legal counsel, assists with the investigation and analysis of potentially |

|compensable events (PCEs) and liability claims filed against the institution, staff and medical resident physicians, and faculty physicians, in conjunction |

|with UW Madison Risk Management Manager and Office of Legal Affairs |

|Evaluates claims and conducts fact-finding with the individuals involved. |

|Reviews and analyzes medical record(s) as necessary. |

|Assists with the discovery phase of all liability and other claims in preparation for settlement or trial that includes coordination of depositions, responses |

|to interrogatories, and requests for production of evidence. |

|Evaluates information required for the defense of claims. |

|Ensures adequate record keeping and data management of claims. |

| |

|PERFORMANCE MEASURES: |

|Timely response to counsel’s request to produce information. |

|Timely completion of investigations. |

| |

|B. ANALYZES INSTUTIONAL ACTIVITY THAT POSES INCREASED RISK FOR PATIENT CARE OR LEGAL ACTION. |

|Based on the analysis of occurrence reporting data, makes recommendations for future analysis/action. |

|Participates in the review and revision of organizational and unit specific policies and procedures pertaining to the reporting of medical device failures and |

|other patient safety policies with risk implications. |

|Acts as liaison and resource to healthcare professionals to assess risk exposures in specific situations. |

|Investigates and reports medical device failures to the FDA and manufacturers, as required by law. |

|Performs queries of the FDA database for medical device failure information. |

| |

|PERFORMANCE MEASURES: |

|Identify deficiencies and promote corrective action. |

|Timely resolution of formal claims and PCEs. |

| |

|C. GATHERS AND DISSEMINATES CONFIDENTIAL CLAIMS INFORMATION AND DATA TO AUTHORIZED INDIVIDUALS AND INSTITUTIONS |

|Maintains a confidential claims database that is designed to track claims information and contributing factors. |

|Continually revises the computerized database to meet expectations for the institution and authorized requesting entities. |

|Complies with requests to supply claims history and insurance coverage information for faculty and resident physicians for reappointment, credentialing, and |

|other purposes. |

|Works with professional liability carrier and the Injured Patients and Families Compensation Fund (PCF) to resolve coverage and related licensing issues for |

|faculty and resident physicians. |

| |

|PERFORMANCE MEASURES: |

|Timely response to authorized inquires related to medical malpractice claims history and coverage information. |

|Database contains complete, accurate and current claims information. |

| |

|D. ASSISTS WITH COORDINATION OF RISK MANAGEMENT EDUCATIONAL PROGRAMS |

|Works with Sr. Risk Management Consultant(s) to coordinate educational sessions for various targeted audiences. |

|Uses available technology, including the hospital intranet, to reach target audiences. |

|Facilitates presentation scheduling to maximize attendance. |

|Explores other media options such as on-line education, video/CD, self-study, RM/Legal intranet site for frequently asked questions, etc. |

|Schedules internal and external presenters. |

|Coordinates all necessary resources for successful presentations, such as catering, travel arrangements, honorariums, etc. |

|Develops and maintains organized documentation of educational programs, handouts, and evaluations. |

| |

|PERFORMANCE MEASURES: |

|Goals and objectives of training programs meet needs of institution. |

| |

|E. IDENTIFIES AND REPORTS CLAIMS TO THE APPROPRIATE INSURANCE CARRIERS |

|Collaborates with the Director of Risk Management when necessary to determine which coverage may apply to the specific situation. |

|Prepares claim reports and other information for submission to insurance carriers. |

|Reviews loss run reports prepared by insurance carriers for accuracy. |

|Assists with Bordereau reporting for potential professional/general liability and employment practices claims. |

| |

|PERFORMANCE MEASURES: |

|Timely and accurate reporting of claims to carrier(s). |

| |

|F. ASSISTS THE DIRECTOR / CONSULTANTS IN THE MANAGEMENT OF THE DEPARTMENT |

|Assists with misc. insurance program needs, including property insurance notification of impairment to fire suppression systems, maintenance of insurance |

|policy documents, etc. |

|Conducts other duties, as assigned. |

|PERFORMANCE MEASURES: |

|Institutes developed goals and objectives. |

|Full cooperation in all assigned tasks. |

| |

|ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS. |

|POSITION REQUIREMENTS |

|Education |Minimum |Associate degree from an accredited institution in business, human resources or related field or|

| | |equivalent years of experience in a legal office setting |

| |Preferred |Additional education or experience in healthcare risk management, business law, accounting |

| | |and/or data analysis preferred |

|Work Experience |Minimum |Two (2) years of experience in risk management, paralegal, or experience in property & casualty |

| | |claims and insurance program management. |

| |Preferred |Five (5) years of experience with professional liability insurance/claims handling preferred. |

| | |Experience with physician claims history and coverage verification for credentialing purposes |

| | |preferred. |

|Licenses/Certifications | |

|Required Skills, Knowledge, and Abilities |Excellent verbal and written communication skills. |

| |Computer skills including spreadsheet, word processing, and claims database experience. |

| |Strong problem solving and organizational skills. |

| |Ability to work independently and to interact with staff, department managers, physicians, |

| |advanced practice providers, and insurance brokers on sensitive issues. |

| |Ability to coordinate training programs. |

| |Ability to work in a team to accomplish goals. |

|PHYSICAL REQUIREMENTS |

|Indicate the appropriate physical requirements of this job in the course of a shift. Note: reasonable accommodations may be made available for individuals |

|with disabilities to perform the essential functions of this position. |

|Physical Demand Level |Occasional |Frequent |Constant |

| |Up to 33% of the time |34%-66% of the time |67%-100% of the time |

|X |Sedentary: Ability to lift up to 10 pounds maximum|Up to 10# |Negligible |Negligible |

| |and occasionally lifting and/or carrying such | | | |

| |articles as dockets, ledgers and small tools. | | | |

| |Although a sedentary job is defined as one, which | | | |

| |involves sitting, a certain amount of walking and | | | |

| |standing is often necessary in carrying out job | | | |

| |duties. Jobs are sedentary if walking and | | | |

| |standing are required only occasionally and other | | | |

| |sedentary criteria are met. | | | |

| |Light: Ability to lift up to 20 pounds maximum |Up to 20# |Up to 10# or requires |Negligible or constant push/pull |

| |with frequent lifting and/or carrying of objects | |significant walking or |of items of negligible weight |

| |weighing up to 10 pounds. Even though the weight | |standing, or requires | |

| |lifted may only be a negligible amount, a job is | |pushing/pulling of arm/leg | |

| |in this category when it requires walking or | |controls | |

| |standing to a significant degree. | | | |

| |Medium: Ability to lift up to 50 pounds maximum |20-50# |10-25# |Negligible-10# |

| |with frequent lifting/and or carrying objects | | | |

| |weighing up to 25 pounds. | | | |

| |Heavy: Ability to lift up to 100 pounds maximum |50-100# |25-50# |10-20# |

| |with frequent lifting and/or carrying objects | | | |

| |weighing up to 50 pounds. | | | |

| |Very Heavy: Ability to lift over 100 pounds with |Over 100# |Over 50# |Over 20# |

| |frequent lifting and/or carrying objects weighing | | | |

| |over 50 pounds. | | | |

|List any other physical requirements or bona fide | |

|occupational qualifications: | |

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