The University of Kansas Health System is a nonprofit healthcare provider that works with the University of Kansas Medical Center across patient care, research, and education. Its services span urgent care and specialized treatment, including cancer care at an NCI-designated center. The health system also supports residency and fellowship programs and promotes wellness for patients and healthcare professionals.
Director of Claims and Senior Counsel – The University of Kansas Health System
Lead liability claims and counsel providers and executives on clinical risk, litigation, compliance, and regulatory matters at a major health system.
विवरण
- Identify and reduce current and emerging risks affecting the health system, its facilities, and providers.
- Oversee professional and general liability claims across the Kansas City, Southwest Kansas City, Great Bend, and Liberty markets, prioritizing community hospitals.
- Support the Office of the General Counsel and its clinical risk management programs.
- Advise on potential losses, risk controls, liability, and regulatory exposure.
- Work with teams across compliance, risk, regulation, patient safety, quality, patient relations, medical staff, and government affairs.
- Review patient safety events and teach practitioners about claims and risk reduction.
- Guide leaders in building a culture of safety.
- Investigate, assess, track, respond to, and resolve claims through the Communication and Resolution Program.
- Serve on crisis management teams at facility or enterprise level.
- Coordinate medical staff investigations while protecting applicable privileges and legal safeguards.
- Present matters to the Risk Retention Group and Captive Claims Committees.
- Develop defense approaches with senior leaders and legal counsel.
- Build and maintain working relationships with brokers, captive managers, third-party administrators, the Health Care Stabilization Fund, insurers, reinsurers, and defense firms.
- Advise practitioners during root cause analysis meetings and investigations.
- Help practitioners complete licensure and credentialing applications.
- Review patient warning, outpatient discharge, and termination letters.
- Partner with Human Resources on records and corrective measures.
- Report potentially compensable events, claims, and lawsuits to the Health Care Stabilization Fund.
- Support trial readiness, litigation holds, discovery, mediation, and trial work.
- Obtain medical records and billing materials for complaints, demands, and claims.
- Provide independent help before claims arise and investigate potential risk concerns.
- Assess patient and family complaints, demand letters, and incident reports, then recommend outcomes.
- Help providers address patient complaints.
- Promote compliance with patient care laws and regulations, incident reporting, and investigations.
- Arrange billing holds, recommend bill waivers, and join bill-hold discussions.
- Coordinate legal counsel, attorney interviews, depositions, and witness preparation.
- Coordinate responses and corrective measures for regulators and enforcement bodies, including OIG, OCR, KDHE, FDA, FBI, and CMS.
- Assist practitioners with licensing board complaints, insurance grievances, and peer review matters.
- Answer agency requests for information and subpoenas.
- Evaluate proposed policies, programs, agreements, and business relationships for risk.
- Assess accident, incident, claim, and occurrence data; report findings and recommend corrective steps to leaders and the Board of Directors.
आवश्यकताएँ
- At least five years managing claims in a healthcare setting or for medical professional liability insurers.
- Juris Doctor preferred.
- At least ten years managing claims for integrated health systems or medical professional liability insurers preferred.
- Law practice license through a state bar association preferred.
- Active Kansas and/or Missouri bar membership is a plus.
- Certified Professional in Healthcare Risk Management (CPHRM) preferred.
- CPCU, RPLU, ARM, and/or AIC designation preferred.
- Able to manage claims through resolution, including confirming coverage, reporting on time, assessing liability, negotiating settlements, attending mediations, and reaching prompt, fair outcomes.
- Strong knowledge of HIPAA.
- Able to read, write, and speak English.
- Knowledge of regulatory codes, legal obligations, and healthcare law affecting enterprise and practitioner risk.
- Strong presentation ability and clear, persuasive communication.
- Able to work independently with minimal oversight.
- Able to handle pressure and stress.
- Able to work effectively with Board members, medical staff, executives, attorneys, accountants, actuaries, brokers, and underwriters.
- Experience with strategic planning, program delivery, and evaluation.
- Knowledge of clinical and non-clinical loss prevention and claims administration.
- Able to set priorities while keeping broader objectives in view.
- Able to delegate and identify when support is needed.
- Track record of developing creative approaches to prevent or reduce risk.
- Litigation background preferred.
- Able to meet the professional, clinical, and/or technical competencies required by the assigned unit or department.
लाभ
- The employer provides equal employment opportunity.
- Reasonable accommodations are available to qualified individuals with disabilities.
- Employment depends on participation in the health system’s dispute resolution program.