Jessica Balesteri Jordan
Springfield,OR
Summary
Clinical Risk Manager with extensive expertise in healthcare, risk management, and patient advocacy. Proven track record in identifying organizational risks and enhancing compliance through meticulous analysis of medical records and effective resolution of patient grievances. Renowned for cultivating a culture of empathy and service excellence while streamlining hospital operations. Committed to continuous improvement and mentoring staff to elevate patient care standards and optimize resource stewardship.
Overview
30
30
years of professional experience
Work History
Clinical Risk Specialist
Samaritan Health Services
10.2023 - Current
- Collaboration with organizational leadership and safety partners to proactively identify clinical risks and implement mitigation efforts to eliminate harm in healthcare
- Embody the principles of high reliability organizing in collaborating with site leadership, Patient Safety Specialists, Quality Improvement, medical staff, and others to help implement and monitor Clinical Risk Management Program and Plan
- Daily identification of clinical risk and safety trends and recommendations made for action plans to mitigate risks to patients, staff, and organization
- Provided comprehensive daily review and analysis of medical records and/or hospital documents to evaluate actual or potential clinical risks in the institution
- Provided expertise on potential and realized claims against the organization and collaboration with the malpractice claims team to develop resolution strategies
- Provided guidance and evaluation to Patient Experience team in review of patient complaints and grievances to identify possible medical negligence or identified risk to the organization and establishing an appropriate action plan and response to patients and families
- Collaborated with financial business partners to evaluate patient/insurance billing in response to adverse events
- Partnered with leadership, Patient Safety, and Enterprise Risk team to respond to adverse events
- Direct and prompt communication with patients and families following adverse events
- Collaborative partner in investigation and developing action plans for patient safety and to come to a fair resolution with patients and families
- Supported the healthcare system in maintaining compliance with accreditation and risk management related standards
- Reviews hospital policies and procedures for compliance with state and federal rules, regulations or standards in collaboration with Quality, Compliance, Privacy, Legal and Enterprise Risk and recommends changes
- Incorporated appropriate regulatory rules and standards into periodic clinical risk assessments to decrease risk exposure and ensure regulatory compliance
- Collaborated with medical staff in dealing with complex patient situations and in resolving issues within applicable state laws, federal regulations, and other regulatory requirements
Clinical Risk Manager
PeaceHealth-Oregon Network
07.2021 - 10.2023
- Coordinated and administered risk identification, investigation, and reduction monitored risk functions and performed risk surveys to assess loss potential
- Supported and ensured the implementation of the system risk management strategies
- Daily collaboration and partnership with Patient Safety, Medical Staff, clinical leaders, and Quality team in review of incident reporting to manage, respond to events, and improve patient safety
- Performed investigations and response to events, potential claims, and grievances presented against caregivers, physicians and the organization for liability and damages
- Investigate missing/damaged belonging cases for the hospital and propose sustainable quality efforts to minimize the likelihood of future loss of property
- Managed and collaborated with clinical and non-clinical teams to initiate reviews and response to patient and family/caregiver concerns, comments, requests for service, complaints, and grievances with any aspect of their health care experience in a timely and comprehensive manner
- Record and collect documents and evidence and maintains work product in accordance with legal requirements and sets up claim
- Ensures collaboration and mitigation of risk to the organization’s insurance coverage against liability and casualty loss
- Collaborated with patient safety, medical and departmental caregivers to ensure timely risk management review and management of serious patient events and medical errors
- Facilitated and/or co-facilitated the review of variances rising to a Sentinel Event, State and/or Federal regulatory reporting and directs the communication of unanticipated events to patients and potential compensable events
- Provided clinical risk management guidance in safety stops including disclosure of unanticipated events
- Represented Risk Management team on Ethics Committee, Environment of Care, Action Response Team, Pharmacy, Safety, Patient and Family Advisory Team, and other assigned committees
- Investigation of alleged abuse and EMTALA violations
- Ensured that applicable regulatory and accreditation requirements are met in a proactive manner
- Participated in development of processes/systems designed to share and recognize performance improvements and compliance across the organization to mitigate risks to patient and caregiver safety/risks to the organization
- Facilitated teams related to system-wide approaches for risk mitigation
- Supported competency development in risk management for community-based resources
- Design training curriculum, develop program content and provide education to leadership teams, quality leaders, supervisors, and staff
- Developed and communicated with senior management on appropriate responses to risk events and medical care complaints in accordance with legal requirements
- Served as a liaison and analytical person in providing guidance for enterprise risk prevention for new clinical services, programs, and equipment
- Partnered in FMEA study with Patient Safety in RCA meetings for serious reportable events
- Managed and immediately responded as 24/7 on-call Risk Manager covering the entire Network, which included 4 hospitals and multiple clinics
- Developed contingency plans to minimize impact of unexpected events on business operations
- Shared lessons learned from past experiences with colleagues through presentations or written materials as part of continuous improvement efforts
Supervisor of Patient Access and Financial Counseling
PeaceHealth
05.2016 - 07.2021
- Led, mentored, and developed a Patient Access team to foster a culture of service excellence, exceptional customer service, and high efficiency in a fast-paced hospital and outpatient environment
- Responsible for the selection, training, performance, and scheduling of assigned staff
- Monitors overall services, developing quality and performance indicators, gathering data for analysis as well as ensuring continuous improvement to optimize patient care and stewardship of resources with patient access
- Oversees day-to-day work of Patient Access and registration for all surgical, inpatient, cardiovascular, and outpatient testing for RiverBend Medical Center
- Strong partnership and collaboration with clinical leaders to evaluate workflow efficiency, resources, equipment, and expenditures
- Regular process improvement and recommendations for enhancements, purchases, streamlining related processes and procedures
- Audits work to ensure compliance with regulatory requirements, policies/procedures and departmental standards relating to HIPAA and other government requirements
- Assumes on-call responsibilities to ensure adequate staffing and problem-solving
- Supports and assists in department functions as needed based on volume and workload
- Initiative-taking in hiring process, monitors team members to evaluate performance and ensure team accountability
- Implemented performance improvement plans to develop staff, providing meaningful and constructive feedback
- Responsible for managing, storing, and return of all patient valuables for inpatients and key stakeholders in patient belongings policy and procedure
- Tracked and analyzed reports covering budgets, operational activities, and department metrics
- Monitored team schedules and delegated tasks to ensure efficiency
- Worked with cross functional departments to maximize productivity and performance
Risk Management Analyst
PeaceHealth
01.2011 - 11.2015
- Daily review, analysis, support, interpretation, and triage of electronic incident report (EIR) data
- Content expert for the EMR system to identify trends and promote process improvements through collaboration with colleagues in quality
- Participation in policy and forms design and contributions for the identification and mitigation of risks
- Managing confidential information in relation to litigation, patient concerns, and incident reporting in a manner that protects both patient confidentiality and organizational privacy
- Daily management and response to patient complaints/grievances in compliance with the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation
- Provided exceptional customer service by rounding and responding to patients and guests in all designated departments for all patient and family concerns
- Created and presented orientation materials on risk mitigation education and incident reporting for all new caregivers to organization including leadership, medical staff, and clinical and non-clinical teams
- Represented Risk Management team on weekly and monthly Safety Committee, Breach Team, Document Advisory Team, and Policy Review Team
Release of Information (ROI) Analyst
PeaceHealth
01.2003 - 01.2011
- Perform a variety of complex tasks within the context of Release of Patient Health Information
- Assist with Entire Legal Health Record process as well as direct team participation on the EMR report
- Collaborate and mentor other departments, staff, and offices within the scope of ROI
- Public speaking and staff training for ROI
- Direct work on policies and procedures
- Manage and provide technical support for all Patient Connection Registration for PeaceHealth
Health Records Specialist
PeaceHealth
01.1998 - 01.2003
- Delivery and processing of medical records to various areas of the hospital, data entry, filing, release of information, knowledge of medical terminology, customer service, reception, birth certificates, typing and computer skills, ability to perform multiple tasks within a limited time, organizational and time management skills
Program & Evaluation Team
Jasper Mountain- SAFE Center
01.1995 - 01.1998
- Managed and led staff in residential and evaluation treatment facilities for emotionally disturbed and abused children
- Supervised, trained, interviewed, hired, supported, and provided feedback directly to treatment team; tracking of daily documentation; crisis management and intervention
- Assisted in oversight of all program functions and routines directly related to on-line staff and residential clients
- Provided insight and information to therapists regarding treatment plans and clinical and family assessments; led staff and family meetings
- Established a safe and therapeutic environment through positive behavioral support, teaching self-help skills, supervision of children, therapeutic and crisis interventions, planning and implementing daily activities and providing a structured living environment
Education
Bachelor of Arts - Psychology
Western Oregon University
Health Information Management -
Lane Community College
Skills
- Risk Management and Patient Safety
- Patient complaints and grievances
- Incident reporting, management, and investigation
- Healthcare operations and navigation
- Legal and regulatory compliance
- Patient rights and advocacy
- Conflict mediation
- HIPAA compliance
- Electronic Medical Record
- Investigation management
- Claim reviews
Trainings and Certifications
- EPIC ADTPA 100-500
- Notary Public, Oregon Commission No. 453211
- Qualified Mental Health Associate, State of Oregon
- Critical Incident Stress Management (CISM) Certification/Training
- Listening to Understand, PeaceHealth
- Language of Caring, PeaceHealth
- PROACT System, Root Cause Analysis Software Training
- ASHRM Virtual Conference 2021-2023
- Annual Northwest Patient Safety Conference 2021-2023
- ASHRM Member 2021-present
- Trauma Informed Care-PeaceHealth Behavioral Health /Samaritan Health Services
- EMTALA Training-PeaceHealth Internal Training
- HRO: Safety Behaviors and Error Prevention-Samaritan Health Services
- Cognitive Interviewing Workshop-The Washington Patient Safety Coalition
- FEMA/Emergency Management Institute Certification in Incident Management System
- Communication and Optimal Resolution/CANDOR Training-Samaritan Health Services
- Just Culture Training-PeaceHealth and Samaritan Health Services
Timeline
Clinical Risk Specialist
Samaritan Health Services
10.2023 - Current
Clinical Risk Manager
PeaceHealth-Oregon Network
07.2021 - 10.2023
Supervisor of Patient Access and Financial Counseling
PeaceHealth
05.2016 - 07.2021
Risk Management Analyst
PeaceHealth
01.2011 - 11.2015
Release of Information (ROI) Analyst
PeaceHealth
01.2003 - 01.2011
Health Records Specialist
PeaceHealth
01.1998 - 01.2003
Program & Evaluation Team
Jasper Mountain- SAFE Center
01.1995 - 01.1998
Bachelor of Arts - Psychology
Western Oregon University
Health Information Management -
Lane Community College
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