Vice President, Legal Affairs and Risk Management

• Serves as the executive leader for Legal, Risk, Compliance, HIPAA, Employee Health Services and Patient Advocate.
• Responsibility over various claims and litigation, including but not limited to, professional liability, general liability, transactional and property loss. Maintains a system for reporting, investigating, securing evidence, and analyzing claims through resolution.
• Manages discovery processes, including but not limited to interrogatories, depositions, document production, requests for admissions, etc. May prepare and represent employees at depositions.
• Recommends reserve amounts and coordinates settlement authority with executive leadership, insurance companies, defense counsel and health system captive (as applicable).
• Participates in case status meetings, settlement conferences, mediations and trials.
• Monitors healthcare regulations and recommends updates to legal, risk management, compliance and other departmental processes and policies.
• Primary hospital contact for responding to CA Department of Public Health complaints and/or Entity Reported Adverse Events; Office of Inspector General, Office of Civil Rights, FBI, Department of Health and Human Services, Department of Justice, Cal OSHA, Federal OSHA, and other regulatory agency matters.
  
• Responsible for various regulatory reporting obligations including Adverse Events and Public Health events (CA Health & Safety Code section 1279.1 and Title 22 events); Safe Medical Devices Act events; HIPAA and/or state privacy breaches; and EMTALA violations.
• Prepares and/or assists others in the preparation of corrective action plans, responses and/or appeals to regulatory agency findings
• Participates in various committees and work groups as needed requiring legal and/or risk management expertise.
• Prepares and presents quarterly Risk Reports to Board of Performance Improvement as well as annual Patient Grievance Program Report and Corporate Compliance Program report.
• Participates in Bioethics Consultations.
• Provides education at Nursing Orientation and at other departments, committees or work groups upon request.
• Reviews and updates hospital policies related to legal, risk management, compliance, regulatory and other hospital policies as needed/requested.
• Works closely with Privacy Officer in the review of Business Associate Agreements and the investigation and reporting of privacy related breaches.  Develops corrective action plans as needed.
• Oversees the hospital Patient Grievance Program. Works closely with the Patient Advocate to ensure timely resolution of patient complaints and effective communication of written responses to enhance the patient experience and adherence to CMS and other regulatory standards.
• Oversees Employee Health Services, ensuring compliance with occupational health regulations and supporting staff wellness initiatives.
• Oversees the hospital Corporate Compliance Program and works closely with the hospital Director of Compliance on a wide variety of regulatory/compliance matters.
• Participates in the Health System Corporate Integrity Board; reports on hospital compliance matters to the system board. Participates in affiliate hospitals’ quarterly Privacy and Compliance meetings. Collaborates with affiliate hospitals on the standardization of HIPAA and Compliance related practices.
  
  

Additional Information

• Strong knowledge of medical malpractice litigation and claims management, corporate compliance, HIPAA, EMTALA, informed consent, and other healthcare related regulations.
• Familiarity with CA Department of Public Health requirements and reporting, state and federal privacy breach reporting, and other healthcare agency practices.