Job Summary
Under the supervision of the Risk Manager, the Patient Relations Specialist serves as the patient advocate in working with patients, family members and health care staff. Is responsible for the coordination and resolution of concerns, complaints and grievances regarding the quality of care and services provided at Unicare Community Health Center. Is responsible for investigating, ensuring timely response and written resolution, tracking complaint trends, trend analysis, and advocating for patient rights to enhance satisfaction and identify systemic issues.
Essential Duties and Responsibilities:
- Investigate & Resolve Complaints: Act as the central point for patient/family concerns, investigating issues related to care and services, and collaborating with clinical and administrative staff for resolution. Addresses patient complaints and resolves issues promptly, adhering to complaints and grievance management policies and procedures.
- Liaison: Serve as a link between patients, families, healthcare providers, and management, communicating concerns and policy explanations. Maintains objectivity and sensitivity while addressing the needs of a patient/customer and supporting staff and services Applies an understanding of the impact of illness and challenges the patient may experience. Maintains poise under challenging situations and a positive dignified demeanor when working with difficult individuals.
- Documentation & Reporting: Maintain detailed records of complaints, track data, identify and generate reports for leadership. Prepares appropriate and professional response correspondence.
- Compliance: Ensure adherence to state and federal regulations in handling grievances.
- System Improvement: Analyze complaint data to pinpoint root causes and recommend systemic improvements, working with quality assurance and risk management. Participate as a member of appropriate committees and task forces aimed at improving quality, safety and reducing organizational risk.
- Patient Advocacy: Champion patient rights, provide education, and support patients during stressful situations, ensuring fair treatment. Assists patients with understanding their treatment plans and medical procedures. Identifies areas of care coordination and facilitates patient access to healthcare services and resources.
- Staff Education: Assists in training staff on patient expectations and best practices for communication and customer service. Develop strategies to improve patient satisfaction
- Confidentiality: Adheres to confidentiality practices and privacy standards. Maintain patient confidentiality and comply with healthcare regulation
- Performs other duties as assigned.
- Demonstrates role model behavior regarding proper customer satisfaction, conduct, confidentiality, complaint resolution, and problem solving.
- Meet deadlines and assist in other duties as assigned
Qualifications:
Minimum Qualifications
- High School Diploma or Equivalent
- 1-2 years of experience as a patient advocate or in a related patient care/customer service capacity within a medical environment.
- 1-2 years exposure to outpatient community clinic systems..
- Supervisory or managerial experience not required, but highly desirable.
- Knowledge of Federally Qualified Health Center (FQHC) standards of practice, legal and ethical codes, and regulations applicable to FQHCs a plus.
- Understanding of local, state, and federal regulations relevant to our industry.
- 1-2 years of social service experience or providing patients with related assistance with social determinants of health.
Preferred:
Bilingual (English and Spanish) with experience working with a diverse population.
Knowledge in medical terminology
Knowledge of eClinical Works.
Special Conditions of Employment:
- Has clean driving record and insurance as required by the state.
- Has reliable transportation.
Knowledge, Skills and Abilities:
- Proficiency in Microsoft Office; Word, Excel and Power Point.
- Experience with compliance-related data management and display is a plus.
- Excellent written and verbal communication skills.
- Independent, reliable, and self-motivated problem-solver.
- Program and/or project management experience required.
- Knowledge of primary care practice management environment is beneficial.
- Strong interpersonal and customer service skills.
- Congenial and able to maintain positive working relationships.
- Solutions oriented with creative problem-solving.
- Able to manage multiple demands and projects simultaneously.
- Able to present information in articulate, organized, and professional manner.
- Cultural sensitivity and demonstrated ability to work with diverse individuals and groups.
- Organizational and administrative skills with meticulous attention to detail.
- Ability to work well under pressure with minimal supervision.
- Flexibility and willingness to handle a variety of tasks.
- Familiarity with principles of PCMH, NQCA, HEDIS, Meaningful Use and Uniformed Data Systems (UDS).
- Experience in health care education, training, or coaching is a plus.
Supervisory experience not required, but highly desirable.
Physical and Mental Requirements:
- Able to lift/move up to 25 pounds, move from place to place.
- Able to stand, bend and reach for prolonged periods.
- Ability to do math, organize and prioritize workload, work effectively and efficiently under stress.
- Ability to supervise, multitask, understand and follow instructions.
- Ability to proficiently read, write, speak and understand English.
Customer Service:
- Actively support UCHC’s mission, vision and core values.
- Provide excellent internal and external customer service.
- Demonstrate UCHC’s Standards of Customer Service Behavior: Compassion, Attitude, Communication, Appearance, Sense of Ownership, and Teamwork.
- Participate in on-going customer service trainings.
- In every action, seeks to promote UCHC as a top service organization.
Risk & Compliance Management:
- Contribute to risk and compliance improvement activities within the organization.
- Follow UCHC policies and procedures and actively engage in the implementation of new initiatives.
- Participate in the continuous risk improvement process as directed by clinic leadership.
Safety:
- Ensures compliance with policies and procedures related to safe work practices.
- Maintain compliance for physical spaces, equipment and supplies.
- Uses all appropriate equipment and/or tools to ensure workplace safety.
- Immediately reports unsafe working conditions.
Privacy/Compliance:
- Ensure the confidentiality of patient, employee, and volunteer information. Such information is accessed on a need to know basis for business purposes only.
- Comply with regulations regarding corporate integrity and security obligations. Reports unethical, fraudulent or unlawful behavior or activity.
- Upholds strict ethical standards.
Flexibility: May travel to all Unicare Community Health Center clinic sites to work or attend meetings as needed.
Physical Requirements and Environmental Conditions
- Pushing and pulling objects up to 25 lbs.
- Frequent wrist, hand and finger dexterity to perform fine motor function.
- Full range of body motion including twisting body, pushing and pulling
- Position requires light to moderate work with 25 lb. maximum weight to lift and carry.
- Position requires reaching, sitting down for long periods of time, walking, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing.
Work Schedule
- You will generally be scheduled to work each day Monday through Friday, with starting times each day varying between 8:00 a.m. and 9:00 a.m. and ending time between 5:00 p.m. and 6:00 p.m., as required to meet the operational needs of the company. There will be occasional Saturdays.
- You will need to travel to other clinic locations.
- Able to accommodate a flexible working schedule including mornings, nights, weekends, and occasional holidays.
Working Conditions
- Non-Ionizing Radiation (microwaves, sun)
- Hazardous Exposure (chemical [E.G. Latex] and infectious)
- While performing the duties of this job, the employee is frequently exposed to fumes or airborne particles
- The noise level in the work environment is usually moderate
- Ionizing Radiation (X-ray, Radioactive Isotopes)
