Under the direction of the Director of Risk Management, is responsible for planning, organizing, communicating, evaluating and implementing the Risk Management and Grievance Management programs for the affiliate hospitals. Serves as the primary contact for investigating and resolving patient and visitor concerns and customer service responsibilities. Assists with ongoing compliance with other standards and guidelines of healthcare regulatory agencies.
This job description is intended to cover the minimum essential duties assigned on a regular basis. Caregivers may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.
Develops, communicates, monitors and evaluates the Risk Management and Grievance Management programs, along with activities to motivate others to achieve Health System and patient safety goals.
Addresses patient and/or patient representative grievances from intake to closure, in compliance with CMS guidelines related to grievance management.
Receives identified and reported problems, including occurrence reports and other serious issues.
Reviews records and conducts follow-up investigations with appropriate individuals related to grievances, potential liability or risk issues.
Develops and maintains systems to track, analyze and report outcomes, while making recommendations regarding prevention strategies based on this information.
Conducts investigations and assists in leading Serious Safety Event meetings.
Assists in leading Root Cause Analysis (RCA) process meetings for identified sentinel events or high severity occurrences.
Maintains an atmosphere that supports and ensures continual dedication toward the patient experience and improved Risk Management and patient safety throughout the Health System.
Conducts and coordinates education/training programs relative to Risk Management, Patient Safety, and Customer Service needs based on identified trends.
Maintains a constant two-way-flow of communication between key areas throughout the Hospital and Health System and with outside vendors, insurance company representatives, etc. as appropriate.
Meets with families and participates in open discussions, including disclosures, with families.
Must be available periodically for after-hours phone calls relating to urgent patient issues in support of Risk Management, Grievance Management, and ethical or legal questions.
Assists in developing and reviewing departmental and administrative policies and procedures.
Prepares reports for and serves on Hospital and Health System committees, as assigned. This shall include, but is not limited to, team meetings in Lansing with Risk Management and Patient Experience Department.
Clearly communicates the mission, vision, and values of the organization to all Caregivers.
Integrates Risk Management and Grievance Management activities with the Performance Improvement process.
Exercises discretionary judgment when acting as a resource and providing direction to Hospital departments in responding to Risk Management and Grievance Management issues.
Conducts investigations assigned by and under the direction of the Director, Risk Management.
Refers cases, as appropriate, to the professional staff peer review process.
Assists in developing practice guidelines and Risk Management notification indicators for high-risk areas.
Assists in the carrying out of administrative responsibilities of the department, including budget, preparation and monitoring, assessment of workflow and reporting requirements, etc.
Performs other related duties, as assigned by the Director, Risk Management and/or Peer Review Committees.
If clinical, must maintain license/certification
See education section above
Bachelors degree in Business, Nursing or Health Care related field and a minimum of 4 years in healthcare enviornment in one of the following areas: patient care, healthcare risk management, patient safety, healthcare claims management, process improvement or quality OR Associate's degree in Business, Nursing or Health Care related field and a minimum of 6 years in healthcare environment in one of the following areas: patient care, healthcare risk management, patient safety, healthcare claims management, process improvement or quality or High school diploma and a minimum of 8 years in healthcare environment in one of the following areas: patient care, healthcare risk management, patient safety, healthcare claims management, process improvement or quality
Specialized Knowledge and Skills
* Effective analytical and oral/written communication skills *Ability to work in a team environment and independently *Ability to handle multiple projects simultaneously *Ability to travel to assigned affiliate locations/facilities. *Outstanding interpersonal communication and written skills *Ability to speak effectively with unfamiliar, upset or angry patients, families, customers *Excellent listening and problem solving skills *Demonstrates ability in word processing, spreadsheets, and data input. (Microsoft Word, Access, Excel) *Familiar with hospital operations, professional and general liability risk issues and professional standards of practice to serve as a resource for staff and physicians. * Demonstrates ability to use a keyboard as may be required to perform the essential duties of the job.
May require travel to community hospitals.
Sparrow Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.