1. MBA in business administration, insurance or business law.
2. 10 year claims management experience working in the insurance industry in the subsequent areas :
- Medical |Mal-practice, workers’ compensation, product liability, E & O, director’s liability, Insurance interpretation, Federal and State regulations| and statues, OSHA Compliance and Joint
- Commission on Accreditation of Healthcare Organizations (JCAHO).
- Reporting Relationship:
3. ICC‘s Director of Hospital Risk Management Reports directly to the chief executive officer (CEO)
4. ICC’s Director of Hospital Risk Management Provide recommendation/reports to Hospital Board of Directors quarterly.
ICC Consults with legal counsel on matters involving hospital professional liability to include litigation matters as:
- Hospital program components, including professional liability, general liability, workers’ compensation, motor – vehicle liability, property, directors | officers, fiduciary liability, ( ERISA, OSHA, HIPPA, JCAHO, Medicare and Medicaid regulations, health-care regulations, state reporting requirements, patient safety, pro-active root cause analysis (PARCA), and RCA.
- Oversee all insurance contracts with insurance providers to include, but not limited to, contract fee for service.
- · Allocate degree of risk through the purchase of commercial liability insurance, self- insurance, self- insurance retention, (SIR), Stop loss policies and set reserves.
Loss control and claims management :
- Monitor incidents and claims reporting system Pursuant to (JCAHO) and ERISA‘s requirements.
- · Investigate a thorough legal defense when obtaining statements, depositions, obtaining production of documents and Interrogatories.
- · Note *** Root Cause Analysis is not protected in the discovery process. The only way that RCA can be protected is if an attorneys investigates an RCA as a work product. Or, under an attorney client privilege. All others are discoverable --- unless there is an exception to the rule which is generally subjective. .
Oversee Hospital Quality Management and Safety Programs:
- Oversee/manage a system to share hospital – wide quality – management and patient safety data with appropriate departments and administrative personnel.
- Oversee/manage a system for tracking and trending of generic screening of potentially high – risk behavior leading to patient, staff and visitor injuries.
Resource for Education on Risk Management :
- Oversee and manages a formal program for ongoing education for all hospital staff including surgeons and ER who are independently contracted.
Administrative Duties and Responsibilities :
- Supervise all professional and support staff in risk management departments
- Monitor department budget and assets of self- insurance funds
Chain of Command in Hospital Administration
· Hospital Board of Directors
- · Hospital CEO/ Vice President Must surrender their Medical license to avoid Ethical Violations
- Chief Financial Officer ment
- Director of Risk Manager is over the following departments
- Chief compliance office
- · Patient safety Manager Workers' Compensation Manager
- · Claims Manager
- Medical Billing | Record
- · Quality Manager PARCA RCA
Note ******* The Director of Risk Management has the authority to fire all medical staff except the CEO, VP CFO. This is a general outline of ICC’s Hospital risk management program that maintains the stability in hospital safety and reduce the risk of loss exposure. Not all hospitals agree with ICC’s approach as there are always alternative ideas that are either a power play or actually work. ICC is just one version of reducing loss run exposure, and maintain quality physicians and having less public negatively.
By Dan Martinez | CEO
ICC Underwriters ®