Executive Director, Professional Medical & Hospital Liability Program
Location: Oakland Job ID: 8952
UC OFFICE OF THE PRESIDENT
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The Office of Risk Services is responsible for developing and implementing Enterprise Risk Management systemwide, identifying and developing strategies to minimize the impact of risk, developing a center of excellence for managing risk, reducing costs and improving safety by executing new ideas and strategic plans in a rapid manner. By strategically managing risk we can reduce the chances of loss, create greater financial stability and protect our resources in support of UC's mission.
To provide leadership, policy direction and oversight of the University's self-insurance programs for Professional Medical & Hospital Liability, Professional Licensing Board, Self-Funded and Human Subject Injury Compensation Programs, and collaboration with the Enterprise Risk Management group.
In addition to management of the above programs, this position supports and maintains a risk-aware culture systemwide, formally bringing consideration of risks into strategic decision making for the involved programs. This involves, but is not limited to, selection and oversight of the University's Third Party Administrator (TPA), claims management, risk financing and insurance coverage issues, loss prevention and regulatory compliance issues related to the above programs.
The scope of these programs includes significant funding and management of liability exposures arising from medical care and treatment at the five University owned medical centers, community based medical school at Riverside, ten campus student health, counseling and psychology centers and athletic training departments and non-medical center clinical activities and affiliated locations. The position approves fees for outside defense attorneys, oversees the legal billing compliance vendor, and works closely with defense counsel, Office of General Counsel, medical center risk managers and the third party administrator on strategic decisions on high exposure cases. The position has the authority and responsibility to review claims and lawsuits and approve expenses and settlements subject to the Regents approval in the resolution of liability actions. The position collaborates closely with the University's captive insurance company in financing and other decisions.
This position manages the third party administrator, works closely with all medical center risk managers, medical center and systemwide medical directors, medical center chief executive officers, school of medicine deans, Office of General Counsel, outside defense counsel, excess insurers, insurance brokers and underwriters, University actuary, and others. Additionally, this position is responsible for management of system-wide clinical incident reporting and feedback system and, along with Office of General Counsel, reporting of settlements to state and federal licensing bodies and system-wide loss prevention.
Self-insured Program Management (Liability, Self-Funded Annuity, Human Research Subject Injury and Licensing Board Programs)
Oversee and manage the activities of the University's third party claim administrators (TPA); review TPA performance and perform claims audits to ensure a high quality of claims administration and a high level of service to the campuses and medical centers. Scope of indirect supervision involves more than 20 personnel.
Provide guidance to campus and medical center Risk Managers, School of Medicine and Nursing Deans, Chief Executive Officers, Chief Medical Officers, and Office of General Counsel; take the lead in solving problems and resolving issues arising from campus concerns. Scope of support to campus and medical center risk managers involves 25-30 personnel.
Oversee the documentation and reporting of claims under the University insurance policies.
Assure continued robust reporting of Precautionary Incident Notifications (PINs).
Select and oversee outside defense counsel compliance with University Defense Counsel Guidelines (including billing compliance vendor) for the defense of the program cases. This indirect supervision involves more than 35 law firms.
Identify, develop and implement processes to improve handling, defense and/or resolution of University claims in an efficient, cost effective manner.
Provide input and guidance on case development and strategy (early investigation), particularly on high exposure cases.
Provide authority to proceed to settlement negotiations in all malpractice cases.
Participate in mediation on appropriate cases.
Provide input and approval to decisions on reporting to California Medical Board and/or National Practitioner Databank.
Design and implement practices and procedures to ensure the financial integrity of the claims management and payment process administered by the University's TPA. Review and ensure appropriate reserving practices by TPA. This involves responsibility for substantial exposures.
Oversee and provide information to University's independent actuary regarding program performance for actuary reports.
Develop policy and procedures and implement program guidelines for all lines of coverage for Defense Counsel and TPA.
Educate University campuses and medical centers regarding program and its focuses.
Negotiate and administer TPA budgets for claims administration services; evaluate self-insured program claims expenses to maximize efficiencies and control/reduce claim and program costs while vigorously advocating on appropriate cases.
Recommend funding strategies and funding levels for the self-insured programs; retain independent actuaries to develop annual funding (premium) requirements for the campuses, and medical centers; develop premium allocation methodologies to equitably distribute the costs of the self-insured programs and provide incentives for loss control.
Identify and pursue opportunities for recoupment of costs from third parties.
Management of run-off self-funded annuities.
Provide coverage analysis and support for human subject research claims.
Responsible for guidelines of coverage and support for licensing board cases.
Loss Prevention and Risk Mitigation
Identify, develop and implement programs and practices designed to prevent and/or reduce losses with campuses and medical center risk management staff; provide advice, oversight, and training to campus and medical center risk management staff at the various locations.
Oversee systemwide incident reporting and feedback (patient relations/experience) systems.
Oversee periodic systemwide meetings with risk managers to share lessons learned, risk reduction efforts.
Oversee annual systemwide event reporting and feedback meeting.
Identify systemwide programs, grants and/or vendors to provide loss prevention or risk mitigation products.
Manage program's premium rebate program, which funds individual grants to each location to reduce risk.
General Program and Enterprise Risk Management
Collaborate with Office of the President financial personnel to develop budget for program.
Participate in requests for proposal and contract negotiations for various product, including systemwide loss prevention or risk mitigation products; manage payment of such contracts.
Interface with TPA and Office of General Counsel to identify, develop and implement improvements to the program.
Maintain awareness of current, relevant California law applicable to program needs and the landscape of professional liability.
Coordination of data management.
Act as liason to the California Patient Safety Organization (CHPSO), and manage University's Patient Safety Evaluation System (PSES).
Develop and implement enterprise risk standards, guidelines, and processes to provide a common understanding and vocabulary for enterprise risk management.
Work with enterprise planning team to seamlessly and successfully integrate enterprise risk management into the enterprise strategic planning process.
Maintain up-to-date knowledge of enterprise risk management issues to ensure high professional standards and enhance the enterprise's risk management policies and practices.
Act as a liaison to campuses, medical centers, and laboratories, champion ERM-oriented approach to risk management.
Collect and analyze information and data required for the insurance underwriting process; participate in negotiations with insurers and develop and present information to insurers on University claims and exposures.
Communicate with and advise underwriters' representatives on high exposure cases.
Collaborate with and provide information to brokers as needed.
Manage collection of full time equivalent exposure data for premium collection purposes.
Provide information and consultation to campuses on insurance and coverage questions. Evaluate and make decisions regarding University defense and indemnification.
Expert and specialized knowledge in the following areas: risk management; insurance; forecasting and analysis; accounting; risk modeling process; knowledge of common organization-specific computer application programs; knowledge of organizational processes and procedures; understanding of organizational rules and regulations.
Expert interpersonal skills, customer service orientation, active listening skills and highly effective team leadership skills.
Advanced human resource management expertise to lead and direct subordinate managers and staff, including advanced skills in comprehensive personnel administration.
Strong ability to multi-task
Advanced skills to appropriately and efficiently respond to and direct the response to emergencies and critical situations, including follow-up evaluation and critique of response efficacy; skills to create, develop and implement changes to emergency situations as required.
Advanced skills in managing highly complex budgets.
Highly developed ability to concisely present complex risk findings and make recommendations verbally and in writing.
Bachelor's degree in related area and / or equivalent experience / training. 10 years of experience with a broad and current knowledge in tort law, insurance coverage, claims administration and claims adjusting practices.
Masters Degree or Advanced degree preferred.
SALARY AND BENEFITS
Salary: $175,000 - $205,000
Benefits: For information on the comprehensive benefits package offered by the University visit: Benefits of Belonging
HOW TO APPLY
Please be prepared to attach a cover letter and resume with your application.
APPLICATION REVIEW DATE
The first review date for this job is July 30, 2020. The position will be open until filled.
Smoke Free Work Environment: The University of California, Office of the President, is smoke & tobacco-free as of January 1, 2014. UC Smoke & Tobacco Free Policy
The University of California, Office of the President, is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status. EEO/AA Employer UC Nondiscrimination Policy
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