Support PDF,DOC,DOCX,TXT,XLS,WPD,HTM,HTML fils up to 5MB
Organization TypePublic Interest
Years of Experience
Date Last Verified
ProfileClinical Regional Claims Manager The candidate serves as liaison to all affiliated health care centers in the investigation, resolution and defense of claims. 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 firm 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 firm 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 firm 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 firm 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.
Qualification and Experience
The candidate should have 3-5 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) is preferred. BSN is required. RN is required. Computer literacy, Powerpoint/Excel skill is a plus. Paralegal Certificate is referred. JD degree is considered. Adjuster licensure and/or CPHRM certification is a plus.
Job ID 5000368050806
Las Colinas Corporate Center II
6363 North Highway 161,Suite 450
Irving, TX 75038