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Osawatomie State Hospital Risk Manager in Osawatomie, Kansas

This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/12108430

Position Summary: This position functions with considerable latitude in formulating, organizing, and directing the hospital’s Risk Management and collaborating with the hospital’s quality assurance process improvement (QAPI) programs. The position requires knowledge of hospital policies and procedures, federal and state laws and regulations, as well as a good working knowledge of other professional, hospital standards and requirements. Work and assignments are self-driven or provided orally or in writing by the Superintendent and or Assistant Superintendent. Reference materials, bench marking & colleague expectations serve as guidelines in producing desired outcomes for full assignments.




Position Description:


Review all incoming incident reports. Assess each report received to determine whether it constitutes a “reportable incident” as defined by statute and assess whether the “reportable incident” occurred at Osawatomie State Hospital. Makes determination regarding standards of care or refers for preliminary review to appropriate supervisor or peer review committee.


Investigates all identified incident reports alleging abuse, neglect or less than standard care by any agency staff in a timely and appropriate manner, as required by conditions of participation and state law. As needed, meets with the Superintendent to update and discuss progress and outcomes of investigations. Contacts area law enforcement in criminal cases and submits information to the DCF Abuse Registry if warranted.


After completion of the investigation, prepares a written report of the investigation findings, makes initial standards of care determination and provides recommendations to eliminate or reduce risks to prevent or mitigation the reoccurrence of similar incidents. The report is provided to the risk management committee and discussed during the committee’s meeting.


Coordinates the hospital Risk Management program by developing the program’s operating policies and procedures; establishing goals and objectives for the Risk Management program; communicating findings and outcomes of the Risk Management activities to the Administrative Executive Committee; recommending changes to hospital policy and procedures to address risk issues identified. Reviews current trends and interprets laws and regulations to responsibly direct the hospitals’ Risk Management programs.


Reviews and maintains current knowledge about national trends with Risk Management in hospitals.; chairs the monthly Risk Management Committee meeting; ensures that the Risk Management Committee approves the final determination for all cases; prepares minutes documenting the monthly meetings; prepares quarterly reports of the committee’s activities and when required by applicable law or regulation delivers the committee’s final SOC determination to the appropriate state agency.


Advises the Superintendent, program directors, department heads and appropriate supervisors of recommendations made by the risk management committee for action to eliminate or reduce risks to prevent or mitigate the reoccurrence of similar incidents. and follows up on the recommendations to ensure completion of recommended action. Periodically reports to the Superintendent the progress toward completion of the recommended action.


Maintains& nbsp;all Risk Management Committee documents and databases in a secure and confidential manner and maintains all risk management confidential records and reports. Provides in-service training and consultations to all agency staff as requested in order to educate staff regarding Risk Management policies/ procedures and laws


Compliance: Provides direct supervision for staff within the Performance Improvement/Accreditation Department. Directs activities of the Department to prepare and maintain compliance policies, procedures and forms for the hospital. Identifies resources needed to support compliance activities. Ensures compliance with federal and state accreditation requirements. Collaborate with leadership, medical staff, nursing staff, ancillary staff, and the Education Department to develop and implement evidenced-based standardized care for multiple acute and chronic conditions. Working with hospital departments on conducting, assisting, and following up on tracers, assisting with and managing mock surveys and follow up, managing the Joint Commission survey, and assisting with other regulatory surveys Assists staff in understanding and executing their roles in the compliance process. Assists staff in establishing formal targets and goals. Provides expertise to services/programs/committees in clearly articulating improvement goals, designing data collection tools, developing reliable d

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