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The University of Kansas Health System · 2 months ago

Executive Director of Claims & Insurance

Kansas City, KS

Full-time

Onsite

Director/Executive

10+ years exp

The University of Kansas Health System is seeking an Executive Director of Claims & Insurance to lead their enterprise risk management program. This role involves collaborating with senior leadership to identify and mitigate risks, manage insurance portfolios, and ensure compliance with regulations while providing leadership to a team of claims professionals.

Clinical TrialsEducationEmergency MedicineHealth Care

Growth Opportunities

Responsibilities

Lead and evolve the health system's enterprise risk management program with a focus on continuous improvement and patient safety

Act as point of contact for captive manager in the day-to-day captive and RRG operations

Manage health system property and casualty insurance portfolio in conjunction with the General Counsel and Director of Insurance

Present risks and appropriate mitigation strategies to senior leadership, influencing prioritization and resource allocation

Facilitate early claims resolution process for serious unanticipated outcomes

Provide claims leadership, including serving as co-chair for the Claims Committee

Actively participate in root cause analysis meetings as appropriate to review adverse/sentinel event occurrences and near misses that affect, or may affect or involve, any UKP practitioner

Monitor external threats, macroeconomic trends, and regulatory shifts. Collaborate with appropriate partners to develop necessary response

Collaborate with University of Kansas Health System (“UKHS”) medical staff and medical staff leadership to facilitate investigations, assuring all relevant privileges and protections are triggered and preserved

Provide independent, unbiased and discrete assistance to UKP practitioners regarding potential claims at the pre-claim stage. Investigate cases identified as potential risk issues, with a goal of avoiding or minimizing the UKP practitioner’s professional liability and harm to professional reputation

Collaborate with UKP Human Resources to ensure that HR-related issues and findings are effectively documented and necessary corrective actions are taken

Champion risk awareness and continuous improvement. Participate in compliance oversight, monitor accreditation and regulatory inspections, surveys and visits. Participate as member of facility or enterprise crisis management teams pursuant to applicable policies

Notify the Health Care Stabilization Fund ('HCSF') of any claims, demands, or lawsuits or issues likely to result in a claim. Review and investigate patient/family complaints, patient demand letters, and incident reports. In collaboration with UKHS and UKP, make recommendations to HCSF if requested regarding disposition of complaints and demands

Assist physicians with response to patient complaints in coordination with Risk Management and Patient Relations. Collaborate with Regulatory, Clinical Risk Management and other relevant departments to facilitate compliance with Medicaid/Medicare and other federal and state regulations

When necessary or prudent, request counsel for practitioner. As requested by the HCSF, serve as the liaison to attorneys for requests to interview UKP practitioners, obtain depositions for subsequent treating practitioners, and identify and prepare UKP practitioner witnesses

As requested by the HCSF, assist with preparation for trials and attend mediations and trials on behalf of UKP and UKP practitioners. Collaborate with Legal and Compliance departments to facilitate responses, including corrective actions to any Statement of Deficiency involving the OIG, OCR, KDHE, FDA, FBI, CMS and other regulatory and/or enforcement agencies. As requested by the HCSF, participate with Senior Leadership and legal counsel in formulating defense strategies

Assist practitioners with answering questions on licensure and credentialing applications which includes obtaining necessary documents to accompany the application

Review peer review requests and prepare documents for peer review committees

Request bill holds; make recommendations for waiver of bills; and attend bill-hold meetings

Review discharge from practice letters and discuss and evaluate patients that physicians wish to discharge from their practice

Assist district attorney or other prosecutor in identifying witnesses for criminal, child custody, guardianship, and child in need of care cases; facilitate practitioner attendance

Ensure compliance with various codes, laws, rules and regulations concerning patient care (including those mandated by state and federal agencies), incident reporting and investigation activities

Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department

These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required

Qualification

Claims experienceRisk managementHealth care lawLeadership experienceAlternative risk financingStrategic planningEffective presentation skillsJuris DoctorBachelor's DegreeRPLU certificationCCI certificationAIC certificationAINS certification