Analyzes and evaluates incident reports and lawsuits, reviews medical records and interviews involved individuals to obtain needed information. Prepares investigative analytical reports for Director and Legal Counsel regarding potentially compensable incidents covered by the Self-Insured Professional Liability Program, and other reports as requested by Senior Management. Coordinates case development, case management, and participates in office management.
Some local travel to other university employee work locations, court proceedings, legal offices, etc.
Primary Duties & Responsibilities
Collaborates with the Director of Patient Safety: in the development of an institutional culture of safety through the design, development, and implementation of systems and processes that improve patient safety; therefore reducing risk to patients, staff, and the University; and in the implementation and management of patient safety event reporting and risk management information systems.
Timely analyzes and reviews incident reports and as entered into the Event Reporting System (ERS). Determines which events should have additional investigation and/or be reported to the excess carrier, based on pre-determined insurance criteria. Timely classifies and codes relevant data for computerized claim reporting system (WUNDER). Prepares a factual summary based on the available documentation.
Coordinates and provides on-line education programs to departments related to Safety and Risk Management issues, including the selection of courses to benefit physicians, nurse practitioners, & physician assistants. In addition, reviews on-line patient education programs (EMMI) for such departments as gastric surgery and plastic surgery.
Communicates in an effective and timely manner to appropriate individuals (i.e. Director of Risk Management, Office of General Counsel, Director of Patient Safety, physician and risk managers of affiliated institutions) the occurrence of adverse events. Represents the University in attendance at debriefings and root cause analyses (RCA) as requested. Advises physicians and others regarding disclosure of adverse events to patients and their family.
Conducts internal claims investigations, plans defense strategies and negotiates disposition of assigned files. Conducts meetings with physicians, analyze medical record information and event reports; direct approved legal counsel and other legal personnel involved in the defense; approve of expert witness reviews; respond to discovery requests and answer interrogatories; coordinates witness preparations; make recommendations for resolution of claim; and coordinate meetings with Director, defense counsel and Office of General Counsel to perform decision tree analysis to determine case value. Attends mediation, arbitration and/or trial.
Prepares and submits required reports to Department Heads, Office of General Counsel, Director of Risk Management, excess insurance carrier, and when applicable, coordinate with external agency investigations, i.e. professional Board inquiries.
Establishes indemnity and expense reserves based on the reserving policy. Negotiates settlements within authority. Reviews and approves defense counsel related bills.
Provides consultation and guidance on healthcare issues such as medical record release, subpoena responses, termination/transfer of care, patient complaints, and physician billing issues including accounts in litigation. Arranges for attorneys to attend depositions with physicians when necessary.
Analytical ability to evaluate facts and formulate questions in order to define problems and critical events in the medical care rendered.
General knowledge of The Joint Commission and patient safety standards, diagnosis and treatment of human disease and injury, medical therapies, procedures, and standard of medical care.
Organizational skill with attention to accurate detail in the preparation of written reports.
Knowledge of methods and techniques of individual case study, recording, and file maintenance.
Equivalent of BS/BA degree.
Prefer three yearsâ™ experience analyzing and interpreting medical or other technical evidence that compares in level of complexity to medical treatment.
Prefer experience in presenting information to a group.
$55,600.00 - $94,900.00 / AnnuallyThe salary range reflects base salaries paid for positions in a given job grade across the University. Individual rates within the range will be determined by factors including one's qualifications and performance, equity with others in the department, market rates for positions within the same grade and department budget.
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All external candidates receiving an offer for employment will be required to submit to pre-employment screening for this position. The screenings will include criminal background check and, as applicable for the position, other background checks, drug screen, an employment and education or licensure/certification verification, physical examination, certain vaccinations and/or governmental registry checks. All offers are contingent upon successful completion of required screening.
Washington University in St. Louis is committed to providing a comprehensive and competitive benefits package to our employees. Benefits eligibility is subject to employment status, full-time equivalent (FTE) workload, and weekly standard hours. Please visit our website at https://hr.wustl.edu/benefits/ to view a summary of benefits.
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Washington University in St. Louis, a medium-sized, independent university, is dedicated to challenging its faculty and students alike to seek new knowledge and greater understanding of an ever-changing, multicultural world. The University offers more than 90 programs and almost 1,500 courses leading to bachelor's, master's and doctoral degrees in a broad spectrum of traditional and interdisciplinary fields, with additional opportunities for minor concentrations and individualized programs. The faculty is composed of scholars, scientists, artists and members of the learned professions. They serve society by teaching; by adding to the store of human art, creativity, understanding, and wisdom; and by providing direct services, such as health care.