Patient Grievance & Relations Specialist (Clinical experience preferred)

Patient Grievance/Relations Specialist 2 (Clinical Background Preferred)

The Patient Relations Specialist II provides support for all components of the system-wide patient and visitor quality and experience program by incorporating high reliability principles into daily work that drives an effective patient relations program. Assists leadership and coworkers on the Patient Relations team to support Department of Patient Experience efforts system wide. Serves as a subject matter expert with service recovery, documentation, investigation, and resolution of patient and visitor complaints system wide. Actively participates in the pursuit and accomplishment of department goals and initiatives to ensure regulatory compliance is met regarding the timely and effective response to patient and visitor complaints and grievances with OU Health. Advocates for and nurtures a system-wide culture of safety for patients, workforce members, providers, and visitors through direct interactions.

Essential Responsibilities:

• Supports the daily operations of the Patient Relations team, including fielding patient and visitor complaints received in all modalities.
• Reviews daily files submitted into Patient Relations software for complaints needing attention or review by the Patient Relations team. Analyzes files not submitted by the Patient Relations team to determine if a submitted file should be escalated to a grievance from a complaint and initiates actions as appropriate.
• Provides service recovery and de-escalation techniques to assist complainants navigate their right to file a complaint with our health system.
• Maintains a team approach to support compliance with regulatory guidelines and timelines as outlined by policy with the timeliness of acknowledgement and resolution letters for patient grievances.
• Composes and mails letters to patients or their representatives including grievance acknowledgements, grievance resolution, valuables reimbursement, and other written communications as needed.
• Inputs data into Patient Relations software to ensure accurate data on trends of feedback received.
• Communicates effectively with leadership to support the identification of areas requiring additional focus by monitoring active trends based on locations, volume, types of concerns communicated, and effectiveness of responses to complaints input into the software.
• Conducts and guides investigations into grievances including guidance to unit leadership, interviewing personnel involved, chart reviews, and hold debriefing sessions as needed.
• Conducts reviews of concerns and determines if additional escalations are required from the complaint including but not limited to the Department of Patient Safety and Regulatory, Ethics and Compliance referral, Human Resources referrals, and service line executive leadership referrals.
• Appropriately follows policy for escalating allegations of abuse, assault, and neglect to applicable stakeholders or law enforcement as needed.
• Maintains a working relationship with Legal and Claims services to manage risk around complaints and grievances.
• Works collaboratively with all levels of system-wide stakeholders to resolve and report out complaints and grievances.
• Serve on committees as needed as a subject matter expert.
• Participate on teams providing recommendations regarding billing adjustments based on working knowledge of specific cases and patient experiences identified in these cases.
• May be called to support Patient Relations leadership with the preparation, running, and scribing of the OU Health Complaints and Grievances Committee.
• Advocates for patients and visitors' requests for assistance or concerns through effective communication with all appropriate levels of OU Health personnel in an impacted area or healthcare team.
• Effectively collaborates in a professional and respectful manner by making recommendations that will help support resolution of a situation.
• May be called to serve on a team or committee as a subject matter expert regarding appeals by patients challenging dismissal from clinical practices.
• Maintain compliance with OU Health policy on flu vaccination and TB testing as applicable.
• Clearly and effectively documents a patient or visitor complaint by making every effort to capture the concern from the perspective of the complainant and taking their voice forward in good faith.
• Maintains working knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the Patient Relations team.
• Follows internal controls and processes designed to promote adherence with applicable laws, accrediting agency requirements, and federal, state, and private health plans. Escalates concerns or recommendations in a timely manner to appropriate chains of command.
• Seeks advice and guidance as needed to ensure proper understanding in the performance of duties.
• Assists with the onboarding and training of new personnel as needed.

General Responsibilities:

• Performs other duties as assigned.

Minimum Qualifications:

• Education: Bachelor's Degree required.
• Experience: 3 years of experience in a healthcare position that provided direct patient and family interactions, or 3 years of experience in a risk management position with direct navigation of patient and visitor complaints involving regulatory oversight.
• License(s)/Certification(s)/Registration(s): None.
• Knowledge, Skills and Abilities:
• Ability to review patient medical records in an EHR.
• Working knowledge of service recovery and de-escalation techniques.
• Proficient in written communication and letter composition.
• Strong communication skills with a diverse range of populations.
• Excellent interpersonal skills with the ability to effectively work collaboratively with all groups of people including executive leaders.
• Demonstrated knowledge of patient safety principles.
• Proficient in computers with proficiency in MS Office products.
• Ability to think analytically, make decisions based on information provided, and apply critical thinking and problem-solving to daily duties.
• Able to work in a challenging, rapidly changing, and fast-paced environment with multiple high priority deliverables.
• Maintain skills in resiliency to be able to process and handle difficult interactions without causing further escalation of the situation.
• Maintain emotional intelligence and awareness.
• Ability to multitask on a routine basis.
• Must have strong telephone and verbal communication skills.
• Be able to speak publicly in a team or committee setting.
• Maintain a professional appearance and be willing to meet with complainants or representatives in-person within a hospital setting.
• Must be a self-starter and driven to be highly productive with minimal supervision.
• Has a firm grasp and can exemplify empathy to patients and their representatives.
• Must be able to speak and write fluently in English and can navigate communications as needed through translation services.

OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.