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Clinical Regional Claims Manager

Company: Christus Health
Location: Irving
Posted on: May 17, 2018

Job Description:

Description
POSITION SUMMARY:

A CHRISTUS Clinical Regional Claims Manager represents CHRISTUS Health and its facilities and providers and provides support to the Vice President of Litigation, the other Clinical Regional Claims Managers and the Claims Team in the investigation, management, resolution and defense of claims, appeals, arbitrations or any other form of disputes. The duties are varied including support of matters in litigation as well as matters wherein litigation is anticipated and other legal matters including subpoenas, court appearances, mediations and trial appearances. Travel is a requirement (50-60%). Location will be Irving System Office.
Serves as liaison to all affiliated health care centers in the investigation, resolution and defense of claims.

MAJOR RESPONSIBILITIES:

Provides support to the Vice President of Litigation, other Clinical Regional Claims Mangers and the Claims Team in the investigation, management, resolution and defense of claims, appeals, arbitrations or any other form of disputes.
Evaluates and investigates patient and claimant complaints and demands and communicates recommendations to CHRISTUS Vice President of Litigation, other Clinical Regional Claims Mangers, the Claims Team, Regional and Facility Risk Managers. Prepares privileged reports with clinical analysis regarding same and provides recommendations to the team for handling.
Negotiates settlements within designated authority; prepare settlement agreements using language of settlement agreements approved by the CHRISTUS Vice President of Litigation.
Attends mediations and negotiate settlements at mediation or directly with claimant or plaintiff's counsel within designated authority and draft settlement agreements.
Identifies and evaluates trend and report analysis of quality and risk issues to assist in reducing the frequency of preventable adverse occurrences. Prepares presentations to facility leadership concerning trends and recommendations for improvement.
Evaluates claimant demands and communicate recommendations to CHRISTUS Vice President of Litigation and Regional and Facility Risk Managers.
Determines if claims require additional investigation, settlement, settlement, or denial.
Investigates all assigned Events, UPLE, Injured Asserts, Attorney Asserts, Medical Review Panels and Suits.
Conducts medical, legal and regulatory research.
On assigned claims, conducts interviews of witnesses, associates, physicians, and claimants.
Recommends reserves with first investigative report and adjustments to reserves as indicated by any follow-up investigation.
Documents claims or event data.
Provides liability analysis and investigative support to defense counsel on commencement of litigation.
Prepares monthly activity status reports (closed/open claims). Prepared powerpoints relative to active claims based on regional assignments.
Monitors trials, mock trials, jury studies and depositions and provide analysis and recommendations regarding litigation management to the CHRISTUS Vice President of Litigation.
Monitors and participates in MMSEA compliance and reporting with the support of internal and external counsel.
Interacts regularly with both internal and external attorneys related to the oversight and management of claims and all matters in litigation.
Coordinates, Plans and Participates in facility quarterly (telephonic) and in person on site annual claims reviews.
Participates in Teaching events across the system as needed including teaching nursing residents on matters related to legal claims.
Participates in risk management surveys of facilities.
Has $10,000 settlement authority to negotiate and resolve claims that are determined to present liability exposure.




Requirements
POSITION QUALIFICATIONS:

A. Education/Skills:
BSN required. RN required.
Leadership and problem solving skills
Computer literacy, Powerpoint/Excel skills a plus.
Demonstrated, organizational and interpersonal skills
Enjoys teaching and public speaking.

B. Experience:
Three to Five years in a health care setting with exposure to some combination of clinical care, risk management or operations
Some legal experience (i.e. Paralegal, Legal Nurse Consultant) Preferred.

C. Licenses:
RN required. Paralegal Certificate Preferred. JDs will be considered.
Adjuster licensure and/or CPHRM certification a plus

Keywords: Christus Health, Irving, Clinical Regional Claims Manager, Healthcare, Irving, Texas

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