This is a description of a Staff Position Classification. It is not an announcement of a position opening. To view descriptions of current openings, please go to UNMJobs and Search Postings to view positions that are currently accepting applications.
The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.
Summary
Within the Office of University Counsel, plans, develops, and implements strategies for achieving and maintaining compliance with university goals associated with settlement agreements, corrective action plans and other components of the McClendon vs. City of Albuquerque litigation as related to the patient care provided at the UNMH Metropolitan Detention Center Clinic. Provides guidance and expert interpretation regarding the UNMH MDC Clinic's compliance with its contract with the Metropolitan Detention Center Health Care Authority. Timely compiles data and prepares monthly and ad hoc reports evidencing the UNMH MDC Clinic's efforts toward compliance with goals. Assists in drafting and implementation of policies and quality assurance audit tools designed to assure achievement of compliance with goals. Investigates and evaluates complex and severe claims, primarily related to medical malpractice. Participates in all aspects of claim file management, under the direction of a claims attorney, including data gathering, investigation, and development of claim summaries and timelines. Prepares and maintains appropriate documentation in applicable databases and information systems. Prepares claim reports and communicates updated claims information to health system entities, as directed. Supports overall mission of the UNMH MDC Clinic operations
Duties and Responsibilities
Determines, gathers, and analyzes evidentiary information necessary to evaluate compliance issues.
Reviews, monitors, audits, and approves processes and paperwork in accordance with parameters established under McClendon vs. City of Albuquerque and UNM policies and procedures.
Participates in planning and developing strategies for quality assurance and quality improvement.
Researches and prepares periodic and ad hoc reports on general and specific compliance, quality and medical liability issues as required by management.
Develops and implements systems and processes to establish and maintain records and applicable databases.
Reviews and collects data for legal or risk management analyses, studies, and monitoring related to organizational compliance; performs and/or participates in the performance of root-cause analysis.
May lead lower level employees; may supervise the day-to-day activities of departmental staff as required in the absence of management.
Assists with and/or directly handles all aspects of a claim file from beginning to conclusion, including the investigation, determination of liability, confirmation of coverage, assessment of damages, and drafting of claim evaluation for recommended action.
Investigates claims, obtains appropriate data, and assembles appropriate medical information and facts regarding claims, including evaluation of clinical charts, interviewing healthcare providers, securing internal reviews, and developing case summaries and timelines.
Utilizes litigation management and claims management information systems to maintain, organize, and retain relevant claims data and files.
Reviews claims for status of investigation, assessment of liability, documentation of damages, adequacy of reserves, evaluation of expert witnesses, documentation of recent developments and current plan for claim resolution.
Manages relationships and provides support for internal and external customers, serving as a primary source of contact and support for individuals named and/or involved in claims and lawsuits.
Maintains cooperative working relationships with other departments and entities in order to facilitate quick responses to internal and external customers.
Participates in problem solving and problem resolution, in accordance with University policy, state and federal guidelines and statutes, and regulatory agency requirements.
Identifies trends and opportunities in medical malpractice claims and participates in reporting and communication, as directed.
May assist with efforts to educate campus constituents regarding risk issues identified through claims data in order to mitigate future liabilities; may assist in the response to discovery requests.
May assist medical malpractice litigation team in matters related to cases involving the UNMH MDC Clinic.
Performs miscellaneous job-related duties as assigned.
Minimum Job Requirements
Bachelor's degree; at least 4 years of experience directly related to the duties and responsibilities specified.
Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.
Knowledge, Skills and Abilities Required
Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
Must have the ability to communicate and work effectively with staff, providers, legal and government community.
Ability to analyze documents and issues and summarize them with accuracy both orally and in writing.
Ability to organize, coordinate and prioritize workload.
Ability to maintain confidentiality of information received.
Ability to communicate effectively, both orally and in writing.
Records maintenance skills.
Skill in the use of personal computers and related software applications.
Ability to interpret, analyze, and advise on the application of settlement agreements and corrective action plans as appropriate.
Ability to write reports containing technical information.
Ability to document work in progress.
Ability to lead and train staff and/or students.
Interviewing and data collection skills.
Ability to create, compose, and edit written materials.
Ability to investigate and analyze information and draw conclusions.
Skill in developing policy and procedure documentation.
Conditions of Employment
Must be employment eligible as verified by the U.S. Dept. of Health and Human Services Office of Inspector General (OIG) and the Government Services Administration (GSA).
Must successfully meet and maintain the minimum background requirements necessary to work within the MDC.
Working Conditions and Physical Effort
Primary work site is the Metropolitan Detention Center where the work may take place in the proximity of inmates in the clinic, the halls or the inmate housing units. Security personnel are a constant presence when inmates are in the vicinity of the work environment.
No or very limited exposure to physical risk.
No or very limited physical effort required.
Work is normally performed in a typical interior/office work environment.
The University of New Mexico provides all training required by OSHA to ensure employee safety.
