Grievances & Appeals Specialist - East Bay Market - Sutter Health
Oakland, CA
About the Job
Organization:
ABSMC-Ashby Campus
Position Overview:
The Grievances & Appeals Specialist supports the patient and family experience through the investigation of patient/family complaints, concerns, and other feedback received by the organizations. Complaints and grievances include, but are not limited to, the care provided by physicians and other health care professionals, potential liability, quality of care, Sutter Health policy and procedure, and extensive conflict resolution with challenging patients and families.
Problems encountered are often of a high level of complexity and require a great deal of innovation. Must collaborate closely with managers, physicians and staff throughout the organization. Collaboration across Legal and Risk Management Services is required on a frequent basis for complex medical legal issues. Assists staff members who request intervention in diffusing difficult or volatile patient situations.
This position requires to travel to different sites; Eden (EMC) Castro Valley, Delta (SDMC) Antioch and Alta Bates Summit (ABSMC) Oakland/Berkeley
Job Description :
+ Investigates patient complaints, provides crisis intervention and mediation for complex situations throughout the institution. Performs case investigation which includes but is not limited to issue clarification through interviews with patients and families, medical record review, policy and procedure review, interviews with hospital staff and physicians, facilitates case conferences, consultation with Risk Management, administration, and other involved departments. Partners with leadership to create action plans around patient complaint investigation/reviews and related quality improvement.
+ Strives to achieve resolution of complaint/problem at the most appropriate level within the organization structure which requires significant interaction at staff, supervisory, department head and clinical/administrative levels. Maintains a Patient & Family-Centered approach working in partnership with patients and families on an individual and system level when reviewing concerns, complaints and/or feedback to improve our organization.
+ With assistance from the leader(s) of Patient Relations and Patient and Family Experience, initiates corrective action as appropriate.
+ Complies with Center for Medicare & Medicaid Services (CMS) Condition of Participation and Sutter Health policies regarding responding to patient/family concerns, complaints and grievances. Communicates action to patients, families, and staff who are involved or will be affected by the results of the investigation.
EDUCATION:
+ _Equivalent experience will be accepted in lieu of the required degree or diploma._
+ Bachelor's: degree in Business Administration, Nursing, Social Work, or other health care related field
TYPICAL EXPERIENCE:
+ 2 years recent relevant experience
SKILLS AND KNOWLEDGE:
+ Oral and written communication skills. must demonstrate writing skills including the ability to synthesize the facts of an investigation and respond with compassion to patients on behalf of the organization.
+ Analytical skills, including medical record review/analysis, investigate of quality of care complaints and synthesize facts to follow up on related patient complaints and related safety issues.
+ Case management skills: ability to manage a high caseload while providing document and timely responses to meet regulatory timelines.
+ Must possess interpersonal, conflict resolution and problem-solving skills while working in a fast-paced environment.
+ Computer skills including word processing, email, calendar and data base, and departmental specific software.
+ Sensitivity to issues of diversity and demonstrates cultural competence.
+ Ability to work collaboratively with managers, faculty and staff throughout the institution.
+ Ability to work independently and be resourceful when navigating complex situations.
Job Shift :
Days
Schedule :
Full Time
Shift Hours:
8
Days of the Week:
Monday - Friday
Weekend Requirements:
None
Benefits:
Yes
Unions:
No
This position is work from home eligible.
Position Status:
Non-Exempt
Weekly Hours:
40
Employee Status:
Regular
Number of Openings:
1
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $38.25 to $57.38 / hour
_The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package._
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.
ABSMC-Ashby Campus
Position Overview:
The Grievances & Appeals Specialist supports the patient and family experience through the investigation of patient/family complaints, concerns, and other feedback received by the organizations. Complaints and grievances include, but are not limited to, the care provided by physicians and other health care professionals, potential liability, quality of care, Sutter Health policy and procedure, and extensive conflict resolution with challenging patients and families.
Problems encountered are often of a high level of complexity and require a great deal of innovation. Must collaborate closely with managers, physicians and staff throughout the organization. Collaboration across Legal and Risk Management Services is required on a frequent basis for complex medical legal issues. Assists staff members who request intervention in diffusing difficult or volatile patient situations.
This position requires to travel to different sites; Eden (EMC) Castro Valley, Delta (SDMC) Antioch and Alta Bates Summit (ABSMC) Oakland/Berkeley
Job Description :
+ Investigates patient complaints, provides crisis intervention and mediation for complex situations throughout the institution. Performs case investigation which includes but is not limited to issue clarification through interviews with patients and families, medical record review, policy and procedure review, interviews with hospital staff and physicians, facilitates case conferences, consultation with Risk Management, administration, and other involved departments. Partners with leadership to create action plans around patient complaint investigation/reviews and related quality improvement.
+ Strives to achieve resolution of complaint/problem at the most appropriate level within the organization structure which requires significant interaction at staff, supervisory, department head and clinical/administrative levels. Maintains a Patient & Family-Centered approach working in partnership with patients and families on an individual and system level when reviewing concerns, complaints and/or feedback to improve our organization.
+ With assistance from the leader(s) of Patient Relations and Patient and Family Experience, initiates corrective action as appropriate.
+ Complies with Center for Medicare & Medicaid Services (CMS) Condition of Participation and Sutter Health policies regarding responding to patient/family concerns, complaints and grievances. Communicates action to patients, families, and staff who are involved or will be affected by the results of the investigation.
EDUCATION:
+ _Equivalent experience will be accepted in lieu of the required degree or diploma._
+ Bachelor's: degree in Business Administration, Nursing, Social Work, or other health care related field
TYPICAL EXPERIENCE:
+ 2 years recent relevant experience
SKILLS AND KNOWLEDGE:
+ Oral and written communication skills. must demonstrate writing skills including the ability to synthesize the facts of an investigation and respond with compassion to patients on behalf of the organization.
+ Analytical skills, including medical record review/analysis, investigate of quality of care complaints and synthesize facts to follow up on related patient complaints and related safety issues.
+ Case management skills: ability to manage a high caseload while providing document and timely responses to meet regulatory timelines.
+ Must possess interpersonal, conflict resolution and problem-solving skills while working in a fast-paced environment.
+ Computer skills including word processing, email, calendar and data base, and departmental specific software.
+ Sensitivity to issues of diversity and demonstrates cultural competence.
+ Ability to work collaboratively with managers, faculty and staff throughout the institution.
+ Ability to work independently and be resourceful when navigating complex situations.
Job Shift :
Days
Schedule :
Full Time
Shift Hours:
8
Days of the Week:
Monday - Friday
Weekend Requirements:
None
Benefits:
Yes
Unions:
No
This position is work from home eligible.
Position Status:
Non-Exempt
Weekly Hours:
40
Employee Status:
Regular
Number of Openings:
1
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $38.25 to $57.38 / hour
_The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package._
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.
Source : Sutter Health