JOB SUMMARY: Investigate claims for medical appropriateness; analyze and process incident reports; provide training to nurses and other patient care staff in matters relating to Risk Management.
Assist claim manager and attorney by analyzing and investigating insurance claims and incident reports submitted to risk management. Review medical record; interview nurses, physicians, and other staff; obtain and read treatises; determine appropriate follow-up required.
Conduct investigation and research to determine university's potential liability regarding each significant incident.
Compile incident report from medical procedural aspect and write report in format which can be assimilated by the hospital administrator, legal staff and others in determining the university's ultimate liability.
Instruct nurses, doctors, and other patient care staff in matters relating to risk management issues; explain the incident reporting system and their legal responsibilities/liabilities for Vanderbilt University Medical Center (VUMC).
Manage all details of incident reporting system and data entry for risk management's computer system; verify data entry for accuracy and resolve problem areas.
Serve as a resource person and consultant for various committees; attend meetings and enlist support and cooperation of medical staff for risk/management goals at VUMC.
Assist in resolving patient billing problems; review bills for appropriateness of treatment and corresponding charges; report on inaccurate or inappropriate charges.
Perform other duties as assigned.
Internal Number: 1905364
About Vanderbilt Health
Vanderbilt University Medical Center is home to Vanderbilt University Hospital, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, the Vanderbilt Psychiatric Hospital and the Vanderbilt Stallworth Rehabilitation Hospital. These hospitals experienced more than 61,000 inpatient admissions during fiscal year 2015. Vanderbilt’s adult and pediatric clinics treated nearly 2 million patients during this same period.Vanderbilt University Hospital and the Monroe Carell Jr. Children’s Hospital at Vanderbilt are recognized again this year by U.S. News & World Report’s Best Hospitals as among the nation’s best with 18 nationally ranked specialties. Vanderbilt University Medical Center is world renowned because of the innovation, work ethic and collegiality of its employees. From our health care advances to our compassionate care, Vanderbilt owes its accomplishments and reputation to staff and faculty who bring skill and drive and innovation to the medical center day after day. World-leading academic departments and comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical advances across the entire spectrum of health and disease.As th...e largest employer in middle Tennessee, we welcome those who are interested in ongoing development in a caring, culturally sensitive and professional atmosphere. Most of us spend so much of our lives at work, we want to be part of maintaining a workplace in which people support one another and encourage reaching for excellence. Many high-achieving employees stay at Vanderbilt because of the professional growth they experience and because of their appreciation of Vanderbilt’s benefits, public events and discussions, athletic opportunities, beautiful setting and, above all, sense of community and purpose.Vanderbilt and its employees share a set of mutual expectations that have been created with productivity, legality, fairness and safety always in mind. We believe that our investment in training and compensating employees multiplies in value when we enable individuals to deliver their best performance for the benefit of us all.