Role Summary :
Responsible for clinical reviews and analyses of medical malpractice claims and assists adjusting staff with the access of medical specialists and trial experts.
Key Duties & Accountabilities :
- Prepares clinical reviews and analyses of medical malpractice claims for technical claim staff. May suggest further investigation to clarify standard of care issues, as well as recommend further specialty options.
- Thorough research and use of MED app provides experts trial witnesses, and assists in evaluating them by attending meetings with them and preparing review reports for claim staff and defense counsel.
- Coordinates literature searches, reviews scientific material and selects appropriate references for trial preparation and claim file documentation.
- Supervises and coordinates consultants who perform Reviews and Analyses on a contract basis to ensure quality of reports, optimal work flow within the department, and / or to provide specific clinical expertise not available within the department.
- Assists in the development of systems, protocols and directions to enhance the productivity of team members, as well as provide communication and direction to the claim technical staff.
- Coordinates advanced expert planning with Claims staff.
Requirements
Minimum Requirements :
Knowledge, Education, Experience, & Skills :
- Nursing degree required or equivalent
- 3+ years experience in a variety of clinical specialties is essential
- Knowledge of health systems organizations, medical nursing and allied health professional standards of care is required
- Knowledge of medical literature and how to use as a resource
- Seeking and providing non-routine or difficult to understand information outside of the department or to client / members, requiring discussion and interpretation.
Interfaces regularly with outside organizations, insured clinicians, SME’s, legal counsel and institutional leaders.
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