[Hiring] Clinical Experience & Grievances Specialist @Stanford Medicine Children's Health

Role Description

This paragraph summarizes the general nature, level and purpose of the job. Responsible for reviewing clinical cases, complaints and grievances to meet and ensure regulatory compliance. This position will specifically be asked to focus on cases where clinical concerns/issues arise that need review to triage to and work alongside the appropriate clinical teams. Responsible for conducting clinically based concurrent and retrospective reviews of both inpatient and outpatient medical records. Reviews clinical progress notes and determines if standards (high level) were met and/or who the appropriate medical leaders are to be pulled into the review. Collaborates with medical management staff in responding to grievance cases. Functions as a resource and a liaison between the patient, the medical center, and the community it serves; ensure patient rights are respected; and provide a channel for problem mediation and resolution to promote the highest quality of care and customer satisfaction.

Supports the family and patient's care by providing non-medical guidance and assistance for the patient and family in assigned areas/tasks. To act as a communication liaison and to hear and understand the patient's individual needs, desires, and concerns, and then to guide and connect the patient and family to a range of non-medical services, amenities, and information that can support effective healing and ensure satisfaction with the hospital experience at Lucile Packard Children's Hospital.

• Manages complaints, grievances and feedback from patients and families with a focus on those of clinical nature and regarding APPs, abiding by all CMS and regulatory requirements.
• Conducts clinically based concurrent and retrospective chart reviews of both inpatient and outpatient medical records.
• Meets regularly with medical management staff in clarifying and resolving clinical grievance and appeal cases.
• Assesses current state/need and identifies the correct clinical team members and seek their feedback to respond to patient grievances.
• Conducts analysis of information gathered and formulates conclusions.
• Identifies patient safety/risk management concerns and follow standard workflows to escalate accordingly.
• Writes responses to complex formal grievances, including multiple perspectives, upholding regulatory requirements, ensuring limited risk and upholding our mission of compassionate care.
• Works alongside and assists the Physician Experience Program Manager to review and ensure timely response for medical staff grievances.
• Collaborates with Patient Relations and Physician Leaders, Risk, PI, Quality/Safety and Regulatory Affairs related to grievance processing.
• Acts as key interface with physician staff, hospital/clinical directors and patient representative to maintain regular communication and documentation among team during the investigation.
• Develops written responses from comprehensive multidisciplinary reviews following established complaint handling pathway.
• Reviews all appropriate documents (letters, reports); analyzes detailed clinical documentation.
• Updates complaint resolutions in the PR database which is used for quality improvement activities for the organization.
• Covers phone line, welcome calls, patient/family rounding as assigned.
• Collaborates with team members to develop improvement projects to address patient feedback.
• Provides support and guidance during patient hospital stay or clinic visit and being responsive to any concerns or complaints the patient and/or family may have.
• Acts as non-clinical liaison/concierge/navigator for patient in all aspects of their care at SMCH.

Qualifications

• Bachelor’s degree in a work-related discipline/field from an accredited college or university.
• 3 years of progressively responsible directly related work.
• Registered Nurse (RN)

Requirements

• Clinical background and knowledge of medical terminology and complex/matrixed healthcare environments.
• Ability to comprehend and discuss patients' medical care and nursing care with medical staff, advanced practice providers, nurses and other healthcare professionals.
• Ability to efficiently review and synthesize information in a patient’s medical record.
• Ability to be diplomatic and highly organized.
• Ability to communicate effectively, both orally and in writing.
• Ability to display a highly professional demeanor and customer service skills.
• Ability to establish and maintain effective relationships with widely diverse groups.
• Ability to handle potentially sensitive situations by applying consultative skills.
• Ability to understand and develop in-depth knowledge of Patient Rights & Responsibilities, Joint Commission standards, and Centers for Medicare/Medicaid regulations.
• Ability to remain calm under pressure and apply sound judgment.
• Ability to resolve conflicts and/or negotiate with others to achieve positive results.

Benefits

• Compensation is based on the level and requirements of the role.
• Salary within our ranges may also be determined by your education, experience, knowledge, skills, location, and abilities.
• Typically, new team members join at the minimum to mid salary range.
• Minimum to Midpoint Range (Hourly): $76.28 to $95.67