SUMMARY: Responsible for managingpatient relations, complaints and grievance activities; liaison betweenpatients, their families, and the organization's physicians, departments and administration.
DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.
1. Overall management of the Patient Complaint/Grievance process, including but not limited to complaint/grievance investigation, data management, response coordination, and resolution.
2. Develops policy and procedure related to Grievance Management.
3. Creates educational materials and provides system wide training.
4. Facilitates coordination of communication between patients, families and medical staff.
5. Assesses the urgency of risk related situations resulting from a complaint or grievance and determines appropriate actions.
6. Performs crisis intervention duties with a view to facilitate resolutions.
7. Conducts investigations and interviews of impacted patients or families to determine nature of care needed and directs them to the appropriate health care providers.
8. Provide patients and families with information on hospital services, procedures and protocols, and resources available to address complaint and or grievance.
9. Creates and maintains communication with insurance companies (BETA Heart) to inquire about payable or paid claims.
10. Monitors status of pending grievances; assists in the Safety Alert System, specially investigations, follow-ups and closure of cases.
11. Provides feedback to patients and families regarding their concerns and complaints.
12. PRM maintains communication with insurance companies (Alameda Alliance, Blue Cross, etc.) and may be required to conducts EMR reviews.
13. Performs other duties as assigned.
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.
MINIMUM QUALIFICATIONS:
Required Education: High School Diploma or G.E.D.
Preferred Education: Bachelor’s degree.
Required Experience: Three years within a healthcare environment.
Preferred Experience: One year crisis intervention experience.
Preferred Licenses/Certifications: Crisis intervention certification.
Pay Range: $48.21- $80.34 / Hour
The pay range for this position reflects the base pay scale for the role at Alameda Health System. Final compensation will be determined based on several factors, including but not limited to a candidate’s experience, education, skills, licensure and certifications, departmental equity, applicable collective bargaining agreements, and the operational needs of the organization. Alameda Health System also offers eligible positions a generous comprehensive benefits program.