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WCIRB The Workers' Compensation Insurance Rating Bureau of California (WCIRB) is California's trusted, objective provider of actuarially based information and research, advisory pure premium rates, and educational services integral to a healthy wo...

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Chief Risk & Litigation Counsel
Refer job# WHOW164978
Chief Risk & Litigation Counsel The candidate will report directly to the Executive Vice President and General Counsel. In conjunction with the Vice President, Quality and Risk Management, the Chief Risk and Litigation Counsel (CRLC) has broad responsibility for the protection of the institution and its patients, visitors, and staff from loss. Coordinates, advises, and facilitates risk-financing strategy with the Vice President, Quality and Risk Management, on issues that could financially put the organization at risk. Specific Activities. Finalize the selection and retention of insurance carriers and/or self-funding mechanisms. Administer self-insurance program through captive management program. Evaluate property exposures, including new construction and renovation programs. Develop familiarity with insurance markets through frequent market contact and attendance at meetings and market symposiums. Co-manage broker and captive manager relationships to plan, coordinate, and administer a comprehensive insurance program involving such activities as insurance purchasing, insurance consulting, claims coordination, and administration of the self-insured program. Directs and coordinates all aspects of insurance management, including developing alternative insurance programs such as self-insurance, risk retention groups, captives, deductible programs, financial plans, reinsurance, commercial insurance and excess insurance. Analyze values and ensure that exposures for property insurance, boiler and machinery insurance, crime insurance, automobile insurance and all other purchased insurance are adequately insured; in the event of loss, prepare data required by brokers and carriers and manage the process through to the settlement of claim. Specific Activities (in conjunction with VP, Quality, and Risk Management) required. Make recommendations regarding settlement of all professional liability (PL) and general liability (GL) claims against the facility. Direct external legal counsel and other personnel involved in claims management and give final approval to defense strategies. Manage and oversee PL and GL litigation for the enterprise and explore feasibility of managing certain litigation in-house, including managing and reducing the expenses of outside counsel litigation. Approve payment of fees for defense counsel and payment of other claims defense expenses. Develop and implement an early intervention program. Include disclosure of unanticipated events, use of apology, alternate dispute resolution mechanisms, early payments strategy, lessons learned /prevention activities and the use of employee assistance programs. Ensure appropriate reporting to all required outside agencies including the NPDB and/or HIPDB. Provide consultation and advice to clinical teams on potential adverse or safety events and complex care situations. Manage the claims program, which contains the following components: Reporting procedures, System maintenance, Detailed claims investigations, Establishment of reserves, Use of alternative dispute resolution mechanisms, Monitoring of legal counsel, Conferring directly with claimants, attorneys, physicians, employees, brokers and consultants, Settlement of claims, Selection and utilization of actuarial firms as needed or requested. Comply with Medicare/Medicaid regulations. Make recommendations to senior management regarding funding levels and coverage limits. Report claims to senior management and captive board of directors. Direct investigative activities. Specific Activities. Develop, implement and monitor the Patient Safety and Loss Prevention Plan. Coordinate all patient safety and loss prevention activities with other clinical loss control, quality management, performance improvement, and infection control initiatives. Coordinate and facilitate all initiatives to comply with regulatory and accreditation initiatives. Plan and implement an institution-wide program of clinical and non-clinical loss control, including a comprehensive orientation program. Direct and conduct educational sessions on risk management for medical staff and employees. Develop, implement and manage the event reporting system. Conduct systems analyses to uncover and identify patterns that could result in compensable events. Assist with the design of risk management and loss prevention program specific to the department and its unique risk. Research, write and implement departmental and facility policies and procedures that affect liability exposures and assist in regulatory compliance. Participate in oversight of patient relations to ensure the timely and effective response to complaints and grievances. Ensure that risks are minimized by following-up and acting on all regulatory/insurance survey report recommendations/deficiencies. Select and utilize all necessary outside consulting services offered insurance carriers, independent risk management consultants, and third-party administrators. Provide senior management with summary reports of incidents, claims, reserves, claims payments, sentinel events and near misses highlighting lessons learned and risk control initiatives implemented. 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. Review and approve all plans and specifications for new construction, alterations and installation of new equipment. Ensure that outside insurance carrier has signed off on plans as appropriate. Provide assistance to the EVP, General Counsel and OGC leadership team regarding legal and regulatory issues that may impact the organization from a patient safety, public relations, marketing, and risk financing standpoint. Those issues might include Fraud/abuse allegations. Reporting to outside federal and state agencies. Reporting to the NPDDB, state licensing boards, CDC. The levying of any sanctions or fines. Recommendations that affect licensing and accreditation. Review of new and existing legislation to determine appropriate risk response. Performs miscellaneous job related duties as requested.

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