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Job Summary:
This Patient Relations Specialist serves as Mary Washington Healthcare’s primary resource for complaint and grievance processing. The incumbent in this position will work to ensure the most positive outcome possible, maximize the experience of care for patients and care givers, minimize liability risks, and impact change to promote an outstanding health experience. This position is responsible for investigating, negotiating, mediating, and resolving patient complaints and grievances that are expressed at and after the time of service. The Patient Relations Specialist will enable patients, families, and caregivers to obtain solutions to problems and serve as an early warning system in the management of claims against the hospital and/or staff.
Essential Functions & Responsibilities:
- Works independently to manage complaint/grievance cases from initial contact, through appropriate documents, investigation, resolution, and response to patients, family members, and care givers within the established standards and policies, including referrals to and from Regulatory Affairs & Risk Management.
- Responsible for the intake, investigation, resolution, and de-escalation of highly emotional, and/or challenging complaints and grievances expressed by patients and/or family members at and after the time of service.
- Independently resolves complaints and grievances through problem solving, crisis intervention, mediation, negotiation, and conflict resolution.
- Investigates and triages complaints to appropriate stakeholders involved.
- Composes written responses to appropriate parties for grievance level complaints.
- Participates in proactive rounding to anticipate and address patients’ needs in real-time.
- Develops and implements sound resolutions utilizing an in-depth knowledge of regulations and compliance.
- Explains/interprets hospital policies and procedures to patients/families in a clear and concise manner.
- Using Root Cause Analysis (RCA) techniques, identifies underlying reason(s) for trends and effectively establishes partnerships for long-term resolution.
- Develops and implements corrective actions to improve organizational performance based on findings from investigations. Demonstrates appropriate sensitivity and judgment in complex situations.
- Exhibits problem-solving, discretion, and creative thinking when addressing complaints and grievances.
- Maintains a knowledge base and understanding of regulatory and legal requirements, inclusive of CMS guidelines.
- Builds relationships and works effectively with leadership and interdisciplinary teams to develop/improve structures and protocols for processing and responding to all levels of complaints and grievances.
- Functions as a coach for leaders and Associates for service recovery to reduce complaints and grievances.
- Documents the processing and reporting of complaints and grievances to meet CMS requirements.
- Conducts mock audits of the complaints and grievance process, preparing the Health System for government/accreditation audits and surveys.
- Analyzes and trends all complaint and grievance data on a monthly and as-needed basis.
- Responsible for complaint and grievance trends and volumes reporting to appropriate stakeholders.
- Performs other duties as assigned.
Qualifications:
- Bachelor’s degree in health/public administration, social work, nursing, or related field required.
- Three to five years of relevant experience preferred.
- Ability to analyze complex clinical data, to include medical records.
- Strong communication skills (oral, written, electronic) to effectively interact with all levels of staff, physicians, and external parties.
- Experience with analytics, project management, independent function and problem solving, and critical thinking is required.
- Excellent word processing, presentation, database, and overall computer skills.
- Knowledge of healthcare operations.
- The flexibility to orient and work at all MWHC locations.
As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.
Required
Physical Requirements: Constant (67-100% of workday) sitting and use of arms and hands; occasional (0-33% of workday) standing, walking, bending, squatting; ability to lift, push, and pull up to 10 lbs.; auditory and visual skills.
Mental Requirements: Possesses critical thinking and analytical skills. Ability to multi-task. Ability to communicate effectively and collaborate with a multi-disciplinary team.
Environmental Requirements and Exposure Hazards: Potential risk of exposure to chemicals.
“It is the policy of Mary Washington Healthcare to provide reasonable accommodations to qualified individuals with a disability who are applicants for employment or Associates.”