Manager PCE System
Baylor Scott & White Health
JOB SUMMARY
: The Manager System PCE provides daily operational oversight and leadership for the Potentially Compensable Events (PCE’s) Team and infrastructure to decrease the risks to BSWH. The Manager System PCE oversees the PCE review process for comprehensive analysis, trending and reporting.
ESSENTIAL FUNCTIONS OF THE ROLE
:
Manages staff in the daily operations for Potentially Compensable Events (PCE’s) across the BSWH system. Provides direct supervision for staff and leads staff as a motivational and supportive leader to engage each in a developmental role. Oversees staff on completing interactions with clinical staff and directs staff with their involvement as required for investigation, feedback, recommendations, and closure.
Directs and teaches staff on proper documentation and recording in database of PCE’s. Educates staff on investigation methodologies and interventions as applicable to enhance the review and reporting process for PCE’s in a timely manner. Develops quality monitoring methods and reports for ongoing assessments and monitoring of volume, trends, and staff performance.
Ensures that a system approach and processes exist for all PCE’s or complaints of professional liability exist for managing in an efficient and effective manner. Established prioritization mechanism is deployed for expediency in handling, investigation, assessment of potential loss to BSWH and resolution. Engages leadership and Risk Management staff when PCE’s may be identified as a serious reportable event or sentinel event. Apprises leadership on PCE’s, escalated matters and maintains ongoing communication as required with respective leadership.
Develops and maintains a system for trending and analysis of PCE’s to enable identification of areas of clinical analysis, significant events, areas for greater focus, and opportunities to reduce risks for BSWH. Compiles, assesses requests, generates data analysis, and facilitates the reporting of data to include the Board, Peer Review Oversight Committee (PROC), PCE SubPROC, and meetings as requested and on a regular basis for Department Head Meetings and ad hoc requests as received for reporting purposes.
Directs and serves as a point of contact for leadership, Risk Management and Patient Relations for PCE’s.
Establishes policies and procedures to assure compliance to best practices, regulations, and insurance reporting requirements. Manages the appropriate handling of BSWH patient accounts with patient billing department.
Oversees the involvement of PCE staff with Patient Relations for coordination of the review and closure process on events to support the regulatory guideline requirements of written communication that may be a source of potential liability. Participates in highly sensitive responses to patients and/or families as requested and directs staff that may participate in disclosures and facilitate resolutions of Potentially Compensable Events (PCE’s).
Seeks technology and innovative ideas to improve work performance, processes and work flow.
KEY SUCCESS FACTORS
:
Excellent written, verbal communication and listening skills. Keen ability to interact effectively with front-line staff, providers, and all levels of leadership in the system.
Outstanding organization and planning skills with attentiveness to detail for managing multiple assignments and projects simultaneously. Directs and supports staff on effectively managing their workload volume.
Extensive knowledge of processes, tools, and techniques for assessing and controlling a system’s exposure to risks of various kinds; ability to apply this knowledge appropriately to diverse situations that department may be involved. Knowledge of the risks faced by patients in a healthcare environment, and the ability to take steps to reduce these risks.
Strong experience working with patient care areas, cross-functional teams, and ability to interact well with all levels of leadership in the system. Ability to collaborate with other departments throughout the health system to leverage existing relationships and activities to resolve patient relations’ matters.
Comprehensive knowledge of claim processing, procedures/systems, auditing, medical terminology and understanding of claim protocols.
Strong knowledge of the legal environment and litigation process.
BENEFITS
Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level
QUALIFICATIONS
- EDUCATION - H.S. Diploma/GED Equivalent
- EXPERIENCE - 5 Years of Experience
: The Manager System PCE provides daily operational oversight and leadership for the Potentially Compensable Events (PCE’s) Team and infrastructure to decrease the risks to BSWH. The Manager System PCE oversees the PCE review process for comprehensive analysis, trending and reporting.
ESSENTIAL FUNCTIONS OF THE ROLE
:
Manages staff in the daily operations for Potentially Compensable Events (PCE’s) across the BSWH system. Provides direct supervision for staff and leads staff as a motivational and supportive leader to engage each in a developmental role. Oversees staff on completing interactions with clinical staff and directs staff with their involvement as required for investigation, feedback, recommendations, and closure.
Directs and teaches staff on proper documentation and recording in database of PCE’s. Educates staff on investigation methodologies and interventions as applicable to enhance the review and reporting process for PCE’s in a timely manner. Develops quality monitoring methods and reports for ongoing assessments and monitoring of volume, trends, and staff performance.
Ensures that a system approach and processes exist for all PCE’s or complaints of professional liability exist for managing in an efficient and effective manner. Established prioritization mechanism is deployed for expediency in handling, investigation, assessment of potential loss to BSWH and resolution. Engages leadership and Risk Management staff when PCE’s may be identified as a serious reportable event or sentinel event. Apprises leadership on PCE’s, escalated matters and maintains ongoing communication as required with respective leadership.
Develops and maintains a system for trending and analysis of PCE’s to enable identification of areas of clinical analysis, significant events, areas for greater focus, and opportunities to reduce risks for BSWH. Compiles, assesses requests, generates data analysis, and facilitates the reporting of data to include the Board, Peer Review Oversight Committee (PROC), PCE SubPROC, and meetings as requested and on a regular basis for Department Head Meetings and ad hoc requests as received for reporting purposes.
Directs and serves as a point of contact for leadership, Risk Management and Patient Relations for PCE’s.
Establishes policies and procedures to assure compliance to best practices, regulations, and insurance reporting requirements. Manages the appropriate handling of BSWH patient accounts with patient billing department.
Oversees the involvement of PCE staff with Patient Relations for coordination of the review and closure process on events to support the regulatory guideline requirements of written communication that may be a source of potential liability. Participates in highly sensitive responses to patients and/or families as requested and directs staff that may participate in disclosures and facilitate resolutions of Potentially Compensable Events (PCE’s).
Seeks technology and innovative ideas to improve work performance, processes and work flow.
KEY SUCCESS FACTORS
:
Excellent written, verbal communication and listening skills. Keen ability to interact effectively with front-line staff, providers, and all levels of leadership in the system.
Outstanding organization and planning skills with attentiveness to detail for managing multiple assignments and projects simultaneously. Directs and supports staff on effectively managing their workload volume.
Extensive knowledge of processes, tools, and techniques for assessing and controlling a system’s exposure to risks of various kinds; ability to apply this knowledge appropriately to diverse situations that department may be involved. Knowledge of the risks faced by patients in a healthcare environment, and the ability to take steps to reduce these risks.
Strong experience working with patient care areas, cross-functional teams, and ability to interact well with all levels of leadership in the system. Ability to collaborate with other departments throughout the health system to leverage existing relationships and activities to resolve patient relations’ matters.
Comprehensive knowledge of claim processing, procedures/systems, auditing, medical terminology and understanding of claim protocols.
Strong knowledge of the legal environment and litigation process.
BENEFITS
Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level
QUALIFICATIONS
- EDUCATION - H.S. Diploma/GED Equivalent
- EXPERIENCE - 5 Years of Experience
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