The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned.
Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.
Must perform all duties and responsibilities in accordance with the hospital’s policies and procedures, including its Service Standards and its Code of Conduct.
*Manages complaints, grievances and feedback from patients and families with a focus on those of clinical nature and regarding APPs, abiding by all CMS and regulatory requirements.
*Conducts clinically based concurrent and retrospective chart reviews of both inpatient and outpatient medical records.
*Meets regularly with medical management staff in clarifying and resolving clinical grievance and appeal cases.
*Assesses current state/need and identifies the correct clinical team members and seek their feedback to respond to patient grievances. Conducts analysis of information gathered and formulates conclusions. Identifies patient safety/risk management concerns and follow standard workflows to escalate accordingly. Writes responses to complex formal grievances, including multiple perspectives, upholding regulatory requirements, ensuring limited risk and upholding our mission of compassionate care.
*Works alongside and assists the Physician Experience Program Manager to review and ensure timely response for medical staff grievances.
*Collaborates with Patient Relations and Physician Leaders, Risk, PI, Quality/Safety and Regulatory Affairs related to grievance processing that ensures the most positive outcome possible maximizing patient satisfaction, minimizing liability risks while complying with internal and external regulations. Supports Patient Rights & Responsibilities and role models excellent customer services and interpersonal communication.
*Acts as key interface with physician staff, hospital/clinical directors and patient representative to maintain regular communication and documentation among team during the investigation.
*Develops written responses from comprehensive multidisciplinary reviews following established complaint handling pathway, to ensure all concerns are given impartial consideration and that appropriate responses occur in keeping with regulatory and hospital guidelines; obtain approvals and signatures and ensure responses are mailed to complainant.
*Reviews all appropriate documents (letters, reports); analyzes detailed clinical documentation.
*Updates complaint resolutions in the PR database which is used for quality improvement activities for the organization.
*Cover phone line, welcome calls, patient/family rounding as assigned.
*Collaborates with team members to develop improvement projects to address patient feedback. Assists with identifying areas for improvement based on daily interactions with patients and observations. Works with unit personnel on initiatives to improve the patient experience.
*Provides support and guidance during patient hospital stay or clinic visit and being responsive to any concerns or complaints the patient and/or family may have. Provides resolution of issues at point of service. Acts as non-clinical liaison/concierge/navigator for patient in all aspects of their care at SMCH before, during or after an encounter with a SMCH site. Serves as a link to services across the health system: social work, pastoral care, physical therapy, other specialties; connecting patients to financial counseling or other care settings.