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Skills
Acute Careunmatched
Analysis Skillsunmatched
Business Administrationunmatched
Case Managementunmatched
Communication Skillsunmatched
Conflict Resolutionunmatched
Content Management Systems (CMS)unmatched
Corporate Policiesunmatched
Crisis Interventionunmatched
Cross-Functionalunmatched
Diversityunmatched
Documentationunmatched
Healthcareunmatched
Hospitalunmatched
Interviewing Skillsunmatched
Leadershipunmatched
Legalunmatched
Medical Recordsunmatched
Medical Treatmentunmatched
Microsoft Officeunmatched
Nursing Administrationunmatched
Patient Careunmatched
Policy Evaluationunmatched
Presentation/Verbal Skillsunmatched
Problem Solving Skillsunmatched
Quality Assuranceunmatched
Quality Managementunmatched
Quality of Careunmatched
Regulationsunmatched
Regulatory Requirementsunmatched
Risk Managementunmatched
Social Workunmatched
Team Playerunmatched
Time Managementunmatched
Writing Skillsunmatched
Description
Experience of Care Specialist
Burlingame, CA 94010 - Onsite
Schedule: Full Time | Day Shift
6-Month Contract
Company Provides all Equipment
Note: MUST be legally authorized to work in the United States.
SUMMARY / DUTIES:
The Grievances & Appeals Specialist supports the patient and family experience by investigating complaints, grievances, concerns, and feedback involving quality of care, provider interactions, hospital policies, and potential liability issues.
This patient-facing role conducts interviews, reviews medical records, evaluates policies and procedures, collaborates with physicians, department leaders, Risk Management, and Legal, and develops resolution plans that comply with CMS regulatory requirements and company policies.
The specialist documents investigations, communicates outcomes to patients and staff, provides conflict resolution and crisis intervention, facilitates case conferences, and partners with leadership on quality improvement initiatives while managing multiple complex cases within required response timelines.
REQUIREMENTS:
Bachelor's degree in Business Administration, Nursing, Social Work, or other healthcare-related field, or equivalent education/experience
2+ years of recent relevant experience in patient relations, patient advocacy, grievance management, or a related healthcare setting
Experience investigating patient complaints, grievances, and quality of care concerns
Knowledge of CMS Conditions of Participation and regulatory requirements related to grievance and complaint management
Experience reviewing medical records and synthesizing findings into clear written documentation
Strong written and verbal communication skills with the ability to prepare compassionate, professional correspondence
Ability to manage a high-volume caseload while meeting regulatory response timelines
Proficiency in Microsoft Office, email, calendar, databases, and department-specific software
Ability to collaborate with physicians, leaders, Risk Management, Legal, and multidisciplinary teams
Strong conflict resolution, mediation, analytical, and problem-solving skills in a fast-paced healthcare environment
PREFERRED REQUIREMENTS:
Experience in an acute care hospital or integrated healthcare system
Experience partnering with Risk Management, Legal, or Quality departments
Knowledge of patient experience improvement initiatives and patient-centered care principles
Experience facilitating case conferences and multidisciplinary investigations
Demonstrated cultural competence and sensitivity to diverse patient populations
Ability to work independently while managing complex, high-priority cases
We are an equal opportunity employer, and we are an organization that values diversity. We welcome applications from all qualified candidates, including minorities and persons with disabilities.