THE HEALTH CARE RISK MANAGEMENT PROFESSIONAL Medical services has changed decisively throughout the course of recent years and this has prompted a development in the job and obligations of medical care risk the board experts In the early long stretches of the calling medical care risk supervisors zeroed in fundamentally on openings that connected with general and expert responsibility Today medical services risk the board experts should oversee those openings as well as openings that connect with oversaw care and capitation dangers consolidations and acquisitions business and laborers remuneration endlessly takes a chance with connected with corporate consistence and hierarchical morals In spite of the huge changes in medical services over the course of the last many years the gamble the executives cycle has remained essentially unaltered and keeps on filling a similar need to keep a protected and powerful medical care climate for patients guests and representatives consequently forestalling or lessening misfortunes to the association Many gamble the board experts are embracing the undertaking risk the executives ERM approach portrayed as a far reaching process that assesses all chance openings standing up to an association starting from the top ERM is a discipline expansive in scope and mirrors an association wide progressing obligation to gamble with the executives standards To be powerful ERM ought to be important for the association s masterful course of action and seen as both a proactive and a responsive interaction This part gives an outline of the job of the medical services risk the executives proficient and the abilities important for carrying out this role in an ever changing medical services climate Data is given about the instructive and experiential foundations of hazard the board experts and about generally held assignments Instructive projects for people who wish to enter the field or for those in the field who wish to additional their schooling are likewise examined THE Gamble Chief S Work Practical AREAS OF Obligation The jobs and obligations of medical care risk the executives experts differ broadly Risk the executives program parts and hence the jobs of the gamble the board proficient are extraordinarily infl uenced by the size and construction of the association and by the gamble fi nancing systems it utilizes The actual calling has developed along practical necessities and developing administrative commands without benefi t of broad scientifi c review or a well defi ned group of information Up to this point no endeavor had been made to measure the numerous exercises that have come to make up the medical care risk the executives proficient s utilitarian work liabilities Thus it is not possible to describe the typical health care risk management professional s job The risk management professional often performs specifi c duties that may result in a variety of titles for the position including risk manager chief risk offi cer or patient safety offi cer refl ecting the expanding roles and responsibilities of the health care risk professional The chief risk offi cer CRO in the health care setting is gaining more visibility in larger organizations and usually resides at the senior management level The title of chief risk offi cer was fi rst used by James Lam at GE Capital in 1993 to describe a function to manage all aspects of risk including risk management back offi ce operations and business and fi nancial planning 1 The CRO position is quickly fi nding a place in health care organizations to respond to increased regulatory pressures and a variety of business risks better known as ERM The role of the patient safety offi cer PSO is founded on the growth of the modern patient safety movement and new patient safety regulations and requirements Restructuring within health care organizations so as to formalize the PSO responsibilities offers risk management professionals and others an opportunity to highlight their current contributions to patient safety develop additional skills and expand their profi le The job description for a patient safety offi cer can vary but the basic functions are identifi ed in Exhibit 2 1 Risk management professionals assuming the additional responsibilities of the PSO may need to enhance their job descriptions with the responsibilities at level one two or three as indicated in Exhibits 2 2 2 3 and 2 4 respectively Additional information on the patient safety offi cer program can be found in Chapter Three In 1999 the American Society for Healthcare Risk Management ASHRM conducted the fi rst role delineation study in health care risk management 2 The purpose of this study was to identify those activities that make up a health care risk management professional s job and thereby defi ne health care risk management s body of knowledge A list of approximately 160 task statements describing various risk management functions and activities was sent to 2 500 health care risk management professionals who were asked to rate the importance of each task The fi ndings suggest that the health care risk management professional s job responsibilities can be divided RISK FINANCING Overview The level two risk manager performs or coordinates the functions outlined under level one and in addition participates in negotiating coverage issues with carriers or trust administrators including levels of coverage scope of coverage and premiums Participates in formulating recommendations for purchase of coverage or funding of self insurance for submission to management for fi nal approval Participates in preparing other fi nancial analyses of facility s insurance program for the information of management and the governing body Specifi c Activities Reviews and maintains insurance policies analyzes existing policies for coverage and exclusions anticipates and deals with policy expirations Participates in managing the facility s insurance programs and fi nancing by preparing statistical data to support the continuation or reduction of premiums paid or reserves Participates in negotiating policy provisions with an actuary SUGGESTED PARAMETERS FOR POSITION May assess appropriate reserve funding levels both insured and self insured in conjunction Experience is intermediate level position with 4 8 years in risk management Position title may include Risk Manager Director RM Director Patient Safety Reports to VP Risk Management COO CFO or CEO Certifi cation Education may