Summary:

Responsible for assisting with evaluation, oversight and management of patient safety, risk management, patient relations and regulatory standards. The Patient Relations Coordinator in the Risk Management Department is dedicated to improving the patient experience through the investigation of complaints, grievances, concerns, and other feedback received at Borrego Health. Responsible for overseeing patient grievances and protecting the rights of the patient as well as the clinical and medical staff.

Essential Duties and Responsibilities:

Administrative Functions:

1. Address all complaints and concerns that may include, but are not limited to, the care provided by physicians and other health care professionals, potential liability, quality of care, health center policy and procedure.
2. Assist with extensive conflict resolution with challenging patients, their families and representatives. The scope of these duties extends to the clinic and off-site clinical areas (for example contracted medical and dental sites).
3. The coordinator is responsible for providing assistance or support as needed to patients, patient representatives and Borrego Health staff.
4. Works with the Risk Management leadership and appropriate staff to resolve highly sensitive and complex problems related to the patient experience.
5. Manage, track and trend all incoming patient complaints and grievances.
6. Investigate and respond to patient complaints and grievances on behalf of the organization and ensure compliance throughout this process.
7. Develop recommendations to all levels of staff to ensure appropriate follow up for internal quality and safety purposes, as well as patient satisfaction and the patient experience.
8. Assist in developing formal communication with physicians, department directors, managers, internal review committees, and the executive team to address organization wide concerns.
9. Manage the Patient Relations Hotline daily by answering calls and monitoring voicemails left by patients, documenting the complaint and entering information into the patient complaint log with a proposed date for response.
10. Send letters of acknowledgement to patients once a complaint has been filed.
11. Intakes and logs professional medical, medical malpractice, and general liability claims.
12. Assist in the data collection and response process for potential legal claims, as well as request for information from various investigative or government agencies.
13. Assists with general and specialized training for staff relating to patient relations, risk management, and customer relations topics.
14. Identifies needs and provides opportunities for staff to acquire and maintain knowledge through informal training and development programs geared towards risk management and patient relations topics.
15. Incorporates current regulatory guidelines and standards into program development.
16. Assists the Risk Management and Compliance departments as needed with priorities and workload.
17. Prepares reports and communicates suggested improvements to stakeholders and appropriate departments.
18. Provides performance improvement recommendations from analysis of trended data.
19. Assist with implementation of risk management, regulatory strategies, initiatives and processes that support optimal performance in the areas of fiscal and qualitative outcomes, patient safety, and regulatory functions.
20. Assists with pro-active policy and procedure development and revisions to meet regulatory and safety requirements.
21. Helps prepare reports for Risk Management, Compliance and Quality Committee meetings.
22. Works collaboratively with the Medical Staff department, Risk Management, Quality, Legal and Operations.
23. Helps facilitate the Risk Committee meetings, prepares agendas, minutes and handouts.
24. Attends meetings and trainings as required by the position.
25. Conducts internal monitoring and auditing as required.
26. Performs their job demonstrating technical ability, understanding of the job expectations and compliance with organizational policies and procedures.
27. Other duties as assigned.

Clinical Functions:

1. Investigates patient complaints, provides crisis intervention and mediation for complex situations throughout the institution. Case investigation which includes but is not limited to issue clarification through interviews with patients, medical record review, policy and procedure review, interviews with clinic staff and physicians, facilitates case, conferences, and consultation with other involved departments
2. Strives to achieve resolution of complaint/problem at the most appropriate level within the organization structure which requires significant interaction at staff, supervisory, department head and clinical/administrative levels.
3. Partners with leadership to create action plans around patient complaint investigation/reviews and related quality improvement.
4. Initiates corrective action as appropriate (both at the individual and organizational level). This may include recommendations for policy and procedures, quality and safety improvement initiatives, billing adjustments, or other final dispositions as indicated.
5. Communicates action to patients and staff who are involved or will be affected by the results of the investigation.
6. Assists patients with identified needs by appropriately referring and connecting them with organizational resources.
7. Excellent, effective oral and written communication with patients, families and staff.
8. Provides timely and appropriate support services to patients.
9. The level of service quality as measured by patient satisfaction and timely resolution of inquiries tracked by Departmental database.
10. Case documentation in database is kept current and contains complete case information.
11. Consistently develops and maintains collaborative working relationships with departments, providers, and other stakeholders throughout the organization.
12. Knowledge of FQHC standards and regulatory compliance issues and meets all regulatory guidelines.
13. Timely management of caseload.
14. Maintains a high level of quality in written responses sent on behalf of Borrego Health to patients.
15. Experience applying quality management/performance improvement approaches.
16. Demonstrated capabilities with Windows based software applications including word processing, spreadsheets and database.
17. Competence reviewing medical records seeking facts required for investigation/quality review.