Risk Manager Focus
How a Near-Death Experience Dramatically Changed This Risk Manager’s Career and Life
In 2000, with a two-week vacation on the horizon, Janet Sheiner decided she wanted to do something different, something “undeniably upbeat and outside of my normal experience.”
Her “normal experience” at least in the professional portion of her life in those days, was doing utilization review (UR) for an HMO.
Sheiner was always drawn to difficult tasks, but the role was starting to wear on her.
“I understood insurance and health care, and I thought I could make a niche for myself in that world by doing the hard stuff,” she said.
“I understood that UR is an important part of keeping health care affordable and protecting members from having unsafe or unnecessary procedures, but it can feel like an antagonistic role by definition, and it wears on you after a while. Essentially, my job was handling denials of coverage — although we didn’t call them denials.”
Seeking a fresh perspective, she found a program offered by UC Davis that aligned willing volunteers with various research projects.
She chose to participate in an expedition in the Sea of Cortez off the coast of Baja, California — a childhood vacation destination she regularly visited with her family growing up in Southern California.
The researchers were studying the impact of El Niño and La Niña on the growth patterns of baby pelicans that populated a series of small, deserted islands.
“We would take these small boats out to the islands, which were protected for the birds, and usually we’d anchor just off the coast and have to swim to shore. Once we got there, the parent pelicans would take off, and we’d have to wrangle the babies, band them and weigh them. Then we’d go back two weeks later to see if they had gained or lost weight,” she said.
“I was speeding toward the edge and I remember thinking, ‘I’m going to die.’”
On one such trip, Sheiner chased after a particularly fleet-footed pelican until she found herself at the top of a gravelly cliff face. She lost her footing and began to slide, grasping at unmoored rocks to no avail, finding nothing to hold on to.
“I was speeding toward the edge and I remember thinking, ‘I’m going to die.’”
Finally, she came to a halt just a foot and a half from the edge. Forty feet below her were the rock-encircled, churning tide pools of the Pacific. On that cliff, with a watery death staring her in the face, she made the decision to turn her career around.
“That experience helped me put things into perspective. If you realize you’re doing something with your life you just don’t want to do anymore, it shouldn’t take something that dramatic to make you reassess where you are,” she said.
Once she returned from the expedition, Sheiner followed through on her promises to herself, chucking the TV, quitting her job and moving south to San Diego from Orange County. But her skills and interests still lived in the insurance industry, so she sought ways to capitalize on them in a more positive way.
“I took about six months off, trying to figure out what I wanted to do. I still liked insurance and helping people navigate it. I didn’t want to abandon it; I just had to find a different way in,” she said.
Again, not shying away from hard work, Sheiner eventually found her way by building an insurance company for a chiropractic and acupuncture practice, writing policies to extend coverage to people who otherwise may not have considered the treatment.
“It felt good because I was extending benefits beyond what was normally available, rather than denying them,” she said.
Though the feeling was a welcome change of pace from her previous position, Sheiner learned toughness and perseverance from her days doing utilization review.
And working in UR does give one the opportunity to do tremendous good, as tough a job as it may be.
“A boss once told me that you don’t prove how good you are on your best day. You prove it on your worst day.” — Janet Sheiner, VP, risk management and real estate, AMN Healthcare Services Inc.
In the 1980s, for example, research surfaced supporting the use of bone marrow transplants in conjunction with high-dose chemotherapy for the treatment of stage 4 breast cancer.
Congress considered legislation to force all HMOs to cover the treatment, and according to the New England Journal of Medicine, more than 30,000 breast cancer patients in the U.S. received bone marrow transplants between 1985 and 1998.
But by the late ’90s, the researchers’ findings had been proven false.
“People who had received transplants were dying sooner and with more pain. So that’s where UR helps to protect people — by denying coverage for treatments that aren’t supported by enough evidence and don’t bring benefit over the long run,” Sheiner said.
“Nevertheless, it’s not easy telling a woman with late-stage breast cancer that the treatment she wants isn’t covered by her insurance.”
Her experience in UR engendered the realization that seeing the big picture and maintaining a positive attitude go a long way in getting through difficult days. Doing the right thing can still feel unpleasant, but it’s all about “coming to a difficult situation with as much positivity and as much integrity as you can.”
“A boss once told me that you don’t prove how good you are on your best day. You prove it on your worst day,” she said.
“Say we have a claim against a clinician that involves real, serious damages. Nothing about it will be easy. But I try to bring my best self to the table, so we can do the right thing for all parties involved and that includes defending the clinician if he or she has done nothing wrong.
“Bad things happen, and when they do, it’s critical to hear every side and keep the big picture in mind.”
It’s a message she continually conveys to her team in her current role as vice president of risk management and real estate at AMN Healthcare Services Inc.
“One of Janet’s greatest strengths is her commitment to the development of her team,” said Denise Jackson, chief legal officer and corporate secretary, AMN.
“She focuses not just on the functional/technical skill, but really spends time to find a path for her team’s growth and success.”
Some on her team look up to Sheiner as a mentor. Alaina Chapman, supervisor of risk management, AMN, credits Sheiner for inspiring her to pursue risk management as a career.
“Janet is a hardworking and very intelligent individual who is strategic and open-minded in her approach to risk management. She has a genuine passion around supporting others’ growth and seeing them thrive,” Chapman said.
Over the course of Sheiner’s tenure as VP of risk management, she’s been able to transform the department from a transactional unit to a true strategic business partner.
“Now the risk management portfolio touches virtually every aspect of our organization and is considered to be a strategic partner in not just mitigating risk, but leveraging it,” Chapman said.
“I have a lot of fun in risk management, and I try to bring an upbeat feeling to my team and foster a sense of enjoyment and excitement,” Sheiner added.
“And it is an exciting time. Risk managers have a unique opportunity to help enable innovation within our organizations, something we need especially in health care as demand increases.”
Sheiner’s battle against the cloud of negativity hanging over her job at the HMO also served as a catalyst for her pursuit of another passion beyond risk management — art.
“I hit a low point emotionally. My whole life was work, and I didn’t really have any hobbies. I was getting myopic,” she said.
“I thought, ‘I’m just doing this to make money, but what is money really?’ It’s just paper. We’ve all entered this collective agreement that an American dollar that’s really only worth a few cents is actually worth $1. So I started cutting it up to challenge myself to think about it differently.”
Folds and fragments of paper bills, coins and even credit cards became raw materials for Sheiner’s sculptures, each with its own geopolitical story behind it.
“Neft Ursa,” or Drunken Bear, is a Russian bear whose clothes are made of rubles, but its eyes, teeth and claws are Soviet coins. It holds a vodka bottle filled with oil.
“Russia is still Soviet at its core in many ways,” Sheiner said. “The oil-filled bottle represents how drunk the ‘bear’ is on its income from oil.”
“Lung Xing” is a Chinese dragon made of Renminbi, whose tail is held up by little men made of American dollars, representing how the American consumer bolsters the Chinese economy.
“The goal is to get people to think more critically about how different parts of the world interact,” she said.
Keeping with that theme, Sheiner and her husband became partners in a cross-border art gallery called The Kitchen Project.
Based in Tijuana, the studio hosts pop-up dinners centered around food, wine and art, bringing in chefs from the San Diego area, Mexico City and Arizona to host exhibitions featuring a new artist at each event.
Sheiner has helped to organize these events for the past eight years and has had her own artwork featured several times.
Josue Castro, a co-partner at The Kitchen Project, said “her sculptures attract a lot of attention. Her work has been very successful. It’s based on a theme we all know — money makes the world go ‘round.”
That creativity comes in handy in Sheiner’s professional life as well. Risk managers are often the gatekeepers between new, innovative ideas and the internal support needed to bring them to life.
As she describes it, the risk management team is often viewed as the “Department of No.” But an open mind and a little ingenuity can help find ways to implement even high-risk propositions.
“Janet has an artist’s mind that provides a different frame of reference that leads to novel approaches. She is incredibly resourceful, which allows her to couple original ideas with practical solutions,” Jackson said.
“What is truly amazing is that Janet’s passion and unique approach gets everyone, including our executive team and board of directors, interested and excited about risk management as a key element integral to AMN’s success. A monumental feat indeed.”
Since joining AMN about six years ago, Sheiner has been able to blend various risk financing alternatives to reduce the company’s total cost of risk and make a tangible impact on its financial results.
Over roughly two decades in various insurance and risk management functions, Sheiner said one of the most important lessons she’s learned is that both life and work are made successful by balancing the difficult and unappealing tasks with those that are uplifting and positive.
And there’s always a way to “shimmy your way back” from the proverbial cliff.
Just ask the pelicans Sheiner studied back in 2000.
The researchers leading that expedition were the same scientists who proved the effect of DDT on birds of prey during the 1970s — it killed a large portion of the pelican population and made them an endangered species — and helped to make the insecticide illegal.
By the time Sheiner made it to the islands years later, the species had recovered.
“It felt good to be a part of something bigger, and it just drove home for me how it’s all about the big picture,” she said. “That helps me keep perspective even today.”
She did, however, eventually give way on the television.
“My husband came with a TV … but I don’t watch it much!” &