Company :Allegheny Health Network
Job Description :
This job is responsible for the oversight and enhancement of all Service Excellence efforts including complaint, grievance, and internal investigations of patient and family concerns. Duties include service recovery and resolution of complaints, management of complaint and grievance process, patient and family advocacy, tracking and trending, reporting and identification of opportunities for improvement in compliance with CMS, Pa DOH, OCR and TJC regulatory requirements.
- Effectively triage, investigate, resolve and document complaints and grievances while ensuring adherence to the Patient Bill of Rights, regulatory requirements and network policy Patient Complaints, Grievances and Compliments. Analyze complaints and grievances data and report trends and/or patient feedback to designated committees and teams. (50%)
- Identify service recovery opportunities and collaborate with clinical and operational teams to address patient and family concerns. Collaborate with clinical and operational teams to effectively de-escalate and provide crisis intervention assistance in difficult patient and family interactions. (10%)
- Identify patient safety and patient rights issues and escalate appropriately. Collaborate with Patient Safety officers to follow Allegations of Abuse algorithm in timely manner. Collaborate with Regulatory leaders to investigate allegations of violation of patient rights, discrimination or EMTALA in timely manner. Collaborate and participate in root cause analyses. (10%)
- Facilitate weekly grievance committee meetings with entity senior leadership. Present data and provide analysis, identify opportunities for improvement at quarterly PIOC meetings. Participate in entity Patient Experience Senior leadership meetings in collaboration with network Patient Experience leadership. Co-chairs the Patient Experience Team. Creates and presents coaching and mentoring education for team members. Assists with additional Patient Experience projects and initiatives as assigned. (10%)
- Design and present teaching, coaching and mentoring service recovery tools and tactics for caregivers and role models Patient Experience Division behavior and performance expectations. Trains and coaches clinical and non-clinical unit managers on timely management of patient complaints and grievances in incident management system. (10%)
- Actively rounds in all departments while demonstrating leadership with conflict management and effective communication skills. (10%)
- Performs other duties as assigned or required.
- Bachelor's Degree in Education, Social Work, Counseling, or Healthcare
1 year with database and/or regulatory reporting and/or proven teaching, training and program management
Customer service skills
Excel, Microsoft Word and Power Point skills
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company. policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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