Job Description

General Purpose of Job:

The Grievance Specialist assumes responsibility and accountability using independent judgement for the management of resources through interdisciplinary collaboration to achieve optimal patient outcomes. The Grievance Specialist reduces barriers to care by identifying patient and family needs with investigation and resolution of complaints and grievances, and sources of emotional and cultural support across the contimuum of care. Additionally, the Grievance Specialist serves as a subject matter expert on grievance management and resolution for the health system.

Essential Duties:

This job description is intended to cover the minimum essential duties assigned on a regular basis. Caregivers may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.

• Leads grievance response and management efforts in accordance with policy.
• Documents all investigation, resolution, and follow up information in the designated complaint tracking system to ensure compliance with all required regulations.
• Audits reports to ensure compliance with CMS regulations regarding timely written communication to patients within the Grievance Process Management framework.
• Coordinates, schedules, and participates in meetings that are necessary to address patient related concerns.
• Develops written responses via letters, emails, social media.
• Monitors the Patient Experience and Physician Experience portals, and follows-up accordingly.
• Compiles and completes data analysis of patient feedback, including tracking and trending of data.
• Coordinates and schedules volunteers/caregivers/physicians to support coaching and validation rounds.
• Maintains and oversees spending to meet financial obligations of the department.
• Maintain current knowledge of regulatory and accreditation mandates along with all applicable processes to ensure compliance standards are met.
• Serve as a role model for compassionate, quality customer service and patient advocacy.
• Serve as representative for customer service/advocacy issues on designated health system committees and task forces developed to address issues involving customer satisfaction.
• Provide support, counseling, and guidance for leadership and caregivers in the prevention and resolution of customer service issues.
• Focus on awareness of and compliance with Patient Rights regulations.
• Serves as a liaison between patients, families, guests, caregivers, and physicians, when concerns need to be addressed. This may include: Bedside visits, family meetings, plan of care meetings, etc.
• Interviews patients or their representatives to obtain relevant information about concerns and/or complaints or special requests.
• Participates in the investigation and reporting of complaints and grievances, which may include: reviewing of entries in the EMR about care delivered and reported issues regarding caregiver behaviors and competencies identified by the patients to obtain relevant information needed to resolve grievances and complaints.
• Maintains a high level of confidentiality/professionalism due to the nature of investigations involving other caregivers.
• Facilitates and participates in on-going communication and follow-up communication with customers of the Patient Experience Department.
• Provides support when other duties are assigned.

Job Requirements

General Requirements	Required Responsibilities of the Caregiver: * Demonstrates knowledge and maintains and respects patient right to privacy by following the HIPAA Privacy and Security policies and procedures. * Adheres to ICARE values and standards of behavior (Innovation, Compassion, Accountability, Respect, Excellence). * Role model behaviors that value the diversity of our caregivers, patients and customers and supports creating an environment that is inclusive, welcoming and respectful. * Communicates with patients, families and customers using AIDET (Acknowledge, Introduce, Duration, Explanation, Thank). * Works in a safe manner and promptly reports any hazards identified in the work environment or related to assigned responsibilities. * Adheres to policies and procedures designed to avoid, prevent and reduce the spread of communicable diseases.
Work Experience	*Associates Degree in healthcare, or hospitality/management field and minimum 1 year of customer service and complaint management experience;, or a High School Diploma/GED and a minimum of 2 years of customer service and complaint management experience.
Education	Education: * Associates Degree in healthcare, or hospitality/management field and minimum 1 year of customer service and complaint management experience;, or a High School Diploma/GED and a minimum of 2 years of customer service and complaint management experience. License / Certification: * None
Specialized Knowledge and Skills	Skills & Abilities: * Excellent computer skills with Microsoft Office products, Microsoft Access, Excel and Word. * Knowledge of patient care practices and medical terminology. * Strong public relations skills with the ability to interact efficiently and effectively with a wide variety of individuals. * Excellent verbal and written communication skills. * Able to make sound independent judgments. * Able to multi-task and prioritize work while receiving frequent interruptions. * Demonstrate strong attention to detail and organization. * Mainatin effective teamwork relationships. * Demonstrates ability to use a keyboard as may be required to perform the essential duties of the job. Knowledge, Skills and Experience Preferred: * Healthcare experience preferred.