Job Description

The Vice President of Risk Management has overall responsibility for the operational, financial, programmatic, and personnel activities of the Risk Management Department of Centra Health, Inc., including its subsidiaries and joint ventures that receive risk management services from Centra.

The position’s main responsibility is to direct risk management issues that impact the strategic vision and direction of Centra and to direct the department’s daily operations, budgeting, fiscal management, claims management, and human resources management, while also ensuring alignment with Centra’s strategic goals and objectives.

The Vice President of Risk Management collaborates with stakeholders, oversees risk financing, claims administration, and loss control, and serves as the programmatic and operational leader of the department. The Vice-President of Risk Management is also responsible for identifying opportunities for risk prevention and mitigation across the system about Centra’s operations. The position reports to the Senior Vice President and Chief Legal Officer and is responsible for developing and meeting departmental goals and objectives, preparing, and delivering reports, and managing financial initiatives, administrative services, and human resources.

Additionally, the Vice President of Risk Management is accountable for creating an environment that fosters diversity, leadership, and professional growth for all members of the healthcare team.

Responsibilities

Departmental Leader:

Interprets impact of broad scope organizational change for staff and develops change strategies for successful implementation.
Incorporates Centra’s vision, missions and values in goals and programs within the Department of Risk Management.
Develops and manages operational initiatives with measurable outcomes.
Formulates objectives, goals, and strategies collaboratively with other stakeholders.
Prepares and delivers reports to operational leadership outlining progress toward meeting annual goals and objectives, to include performance related to finance, clinical activity, Enterprise Risk Management activities and personnel.

Insurance/Risk Finance

Responsibility for all operations of the risk financing program related to Hospital Professional and General Liability, Worker’s Compensation, Management Liability, Automobile, Network and Privacy Liability, Errors & Omissions, Provider Excess (Managed Care Stop Loss), HMO reinsurance and any other such coverage as may be procured in the future
- Designs, establishes, and administers system-wide processes for risk transfer and risk assumption. Analyzes the benefits of risk transfer versus risk retention or the combination of both. Formulates recommendations for purchase of insurance coverage, alternative risk transfer or self-funding and articulates the strategy to management and implements the selected strategy.
- Evaluates new exposures to ensure coverage and minimize risk.
- Leads team of professionals in the development, analysis, evaluation and implementation of insurance renewals and directs funding analysis for complex alternative risk financing vehicles for Centra, both existing and proposed.
- Directs and oversees preparation of applications and specifications.
- Negotiates with brokers, insurers and reinsurers on coverage, service and premium.
- Supervises the collection and analysis of statistical exposure data.
- Addresses state and federal regulatory requirements related to insurance placement and self-insurance.
Continually evaluates strategy for emergence of new risk exposures to manage and mitigate, both traditional and emerging enterprise risks.
Identifies, evaluates, recommends and implements new insurance programs to support the strategic goals and objectives of Centra. Administers and directs the operations of Centra’s captive insurance company and other self-insurance programs.
- Facilitates the captive strategic planning process; executes and monitors performance of strategic plan.
- Oversees operational performance of Trinity’s captive and its service providers
- Assures compliance with all regulatory requirements.
- Serves as Centra’s liaison for all regulatory, insurance and operational matters
Direct strategy and operation of insurance programs for medical staff.
Monitors and evaluates the effectiveness of existing services and programs against established metrics.
Directs and oversees claims in all lines to assure that all parties are abiding by the contracts written for coverage.
Lead, directs and advises senior leadership on the risks contemplated during mergers, acquisitions and divestitures.

Financial Manager

Actively seeks opportunities to improve financial outcomes, engaging staff in the process.
Monitors and analyzes financial data and utilizes it for decisions regarding FTE’s, staffing and operational budget.
Establishes an annual operating and capital budget, demonstrating fiscal responsibility through meeting budget targets.
Articulates to staff the budget and the context within the organizational financials.

Claims Management

Responsible for the overall direction of claims management including supervision of staff and outside counsel for all lines of coverage.
Establish appropriate reserves for claims self-insured through Centra’s captive insurance program
Mitigates an organization’s exposure to risk by formulating, developing, and coordinating all claims-related activities, as well as resolving bona fide claims at the least possible cost through various risk transfer techniques.
Directs a program to ensure the proper and efficient handling of claims, gathering data on claims for both record keeping and loss forecasting purposes, and estimating the financial value of claims.
Responsible for post loss reduction techniques such as salvage, subrogation and rehabilitation.
Manages litigated and complex claims and is entrusted with significant settlement authority.
Understands and communicates claims management philosophy and strategy to executive leadership, business units and regional management.
Supervises, builds, maintains, and manages relationships with claims adjusters, insurers, outside legal counsel, and other claims related parties.
Ensures external reporting requirements are met.
Operationalizes the design, analysis and delivery of claim information which influences risk management behavior through performance metrics and benchmarking.

Administrative Leader

Contribute to the success of the Centra by providing leadership, direction and coordination of operations, finances, and human resources for area of responsibility.
Manage and direct all activities within area of responsibility.
Continually assesses all services, identifies problems, utilizes data to analyze and propose innovative approaches for solutions.
Engages staff and other stakeholders in continuous improvement of systems and processes; manages resources for staff participation in improvement work activities.
Remains current of new trends and best practices and incorporates into Risk Management practices and programs.
Effectively facilitates meetings at Risk Management and organizational level.
Creates bi-directional systems that effectively communicate information and data, utilizing multiple methods.
Communicates with physicians, academic department leaders, and senior administrators to maintain coordination with other Centra programs.
Manages complex interdepartmental and interdisciplinary relationships to assure collaboration and effective/efficient operations within the Risk Management Department.
In conjunction with other System Office departments (i.e., finance, clinical, human resources, legal) develops, recommends and implements strategic and operational initiatives for Centra.
As a member of the leadership team, manages the department’s operations and organization, which includes recruiting, training, developing and directing the department staff, developing goals and objectives, and establishing and adhering to the department annual budget.
Provides education and develops support among system leadership for alternative risk financing, insurance, captive and physician programs.
Oversees development of system enterprise risk management initiatives including the adherence to system policies and procedures.
Develops measures that demonstrate effectiveness of operating performance and strategies.
Serves as lead individual to incorporate new hospitals and affiliate organizations into all programs and services related to Centra’s Insurance and Risk Management Services Department. This includes presenting the quality, cost flexibility, cost effectiveness, and implementation process for the programs and services.
Represents Centra in internal and external risk management leadership roles with an emphasis on developing local relationships.

Qualifications

Required Education

Advanced degrees or certifications in a combination of Finance, Insurance and/or Business Administration.

Required Experience

At least 10 years risk/insurance management experience preferably with a multi-institutional system that includes physician practices and ambulatory and other non-acute organizations.
Must have strong knowledge of:
- Financial analysis, underwriting, risk financing, loss prevention, claims administration.
- Captive insurance company operations and governance.
- Regulatory requirements of domestic (US) and non-domestic Self-insured program. operations; risk retention groups.
- Group risk financing programs.
- Insurance and reinsurance markets and underwriting.
- Benchmarking and metrics monitoring.
- Claims Management and administration.

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