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Oversees Optum West clinical risk management program including the Adverse Event Response Team (AERT). Assesses and analyzes adverse event data, directs investigations with significant clinical risk events, develops action plans, develops, and delivers education and training.
Responsible for providing strategic leadership and participating actively in the clinical risk management program for the Optum west region. Promotes a culture of safety in all interactions with teammates, clinicians, and leaders utilizing a just culture framework to produce system-level solutions to safety events. Responsible for identifying and responding to reported safety concerns and guiding both proactive and reactive changes. Changes are in partnership with market leaders, event reporting file managers and Subject Matter Experts (SMEs) within Optum who assist in the investigations to resolve events related to patients, visitors, clinicians, and teammates. Analyzes and assesses data collected through the event reporting system to identify actionable trends and ensure proactive steps are taken to mitigate risk. Partners with national clinical risk management, compliance, and legal counsel for consultation and transfer of events as indicated. Assists in Peer Review referrals.
Primary Responsibilities:
Adverse Event (AE) Reporting Responsible for the identification and triage of Optum west region adverse events, and the oversight of the Adverse Event Reporting Team (AERT) market designees to achieve consistent and timely review Oversight of the adverse event response system to assure events are appropriately addressed and documented, as well as completed in a timely manner Reinforce processes and define event response accountabilities with market leadership and the AERT As appropriate, recommend events for attorney-led event analysis calls (e.g., ALEA calls) in coordination with Risk Analyst and in consultation with Risk Attorney Timely identification and reporting of claims and potentially compensable events (PCEs) to litigation counsel Engage with appropriate SMEs in event reviews as indicated (e.g., compliance, human capital, privacy, senior medical leaders, AERT, etc.) Analyze trending reports from the event reporting system, identify actionable trends and recommend appropriate corrective actions Support the Peer Review process Inform and review all potentially reportable events and UHG “Signal Events” with the Chief Medical Safety Officer, Optum West Investigations Oversee the process for all adverse events to ensure appropriate resolution is completed and documented Lead investigations related to high severity and/or high frequency events, involving a multidisciplinary team of senior leaders as appropriate Assess events for potential liability risks and communicate with litigation team regarding PCEs RCA: Manage and lead certain Root Cause Analyses (RCAs), working cooperatively with involved leaders, SMEs, and the national clinical risk management team to guide the progress to resolution and action(s) ALEA: In coordination with Risk Attorney, participate in ALEA calls; investigate and follow up on outstanding items identified in ALEA calls and coordinate conversations with SMEs and involved clinicians regarding the event Consulting Provide advice, consultation, and support for clinical risk issues to market staff, clinicians, and leadership. Link market with appropriate resources (e.g., privacy, compliance, human capitol) Review and recommend changes to market and regional policy where appropriate Mitigation Recommend and assist with development of corrective action plans or system improvements that may be necessary In consultation with Risk legal resources and local leadership, recommend updates to policies, procedures, and systems for markets and the region based on the results of investigations Actively participate in the creation and education of risk toolkits to identify and mitigate losses Review with Director recommended process changes for any risk of loss to organization, and for consideration of whether wider implementation to other markets is warranted Analyze trending reports from RLDatix to proactively identify risk reduction opportunities and to design and implement appropriate interventions In coordination with Risk Analyst, may communicate with patients regarding demands for compensation to collect information and communicate with appropriate partners, including Litigation Counsel, Risk Attorney, and Business Attorney Training and Education Participate actively in the content planning, coordination, and presentation of risk management education for staff and providers in Optum west region Conduct medical and risk management research Participate in external risk management training to maintain and advance knowledge, skill set, and networking opportunities
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Bachelor’s Degree “BSN” or equivalent experience Graduate from an accredited school of Nursing Current, unrestricted RN license in USA 3 years of experience working as an RN Proficiency with Microsoft Suite Demonstrated ability to communicate effectively Ability to travel up to 10%
Preferred Qualifications:
MSN or JD Certified Professional in Healthcare Risk Management or prior risk-related education Ability to lead teams and manage projects
The salary range for this role is $106,800 to $194,200 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.
