CMS Grievance Coordinator – CMS Grievance – Willard Hospital

Overview

The CMS Grievance Coordinator is responsible for the day-to-day work with the tracking and case management of patient-related concerns, grievances, complaints and appeals received for assigned client hospital(s). This position will receive, respond and log grievances while providing investigational support and follow-up as necessary as part of the hospital response and/or appeal to a patient grievance pursuant to CMS guidelines and/or managed care requirements including state regulation(s).

This position must function in collaboration with clinical quality, hospital operational leadership and the risk department (CMS Conditions of Participation are the guidelines that hospitals must follow to receive Medicare funding).

• Will appropriately acknowledge the receipt of all concerns, grievance/appeals and track utilizing the case management workflow methodology instructed from the BSMH Quality department.

• Responsible for the gathering of all pertinent and relevant information from the patient and/or family member regarding the grievance/appeal, determining the appropriate resolution of the grievance/appeal per standard policies and procedures; and notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue(s).

• Provides investigation and follow-up related to patient grievance(s) ensuring appropriate resolution in writing as required by hospital policy and CMS Conditions of Participation.

• Collects, analyzes, and reports data through the quality reporting structure of the organization to the facility Grievance Committee and other leaders as determined by policy and/or facility leadership. Assists in preparation of annual report of the grievance/resolution process to Board of Trustees.

• Collaborates with quality, risk, and leadership team to investigate and ensure appropriate follow-up of grievance. Communicates effectively with patient, family, and hospitals leaders.

• Utilizes appropriate databases for data entry and issue tracking. Maintains accurate and timely documentation, including complete database, issue tracking and files of all concerns, grievances/appeals.

• Develops excellent relationships with department leaders, medical staff and others to fully investigate and resolve issues.

• Possesses excellent letter writing and computer skills with knowledge of Word, Excel and Power Point and a willingness to work within the electronic medical record as necessary.

• Able to represent the hospital in meetings and presentations to patient families and medical staff in relation to the grievance process. Demonstrates ability to identify and define problems, collect data/information, establish facts and draw valid conclusions with critical thinking skills.

• May be asked to be part of the Incident Command Center during a crisis by assisting the Family Information Center.

• Must possess a high degree of professionalism and able to set goals, prioritize and achieve results in accordance with the highest standards and applies procedures to reflect hospital and professional practice standards interpretation with clinical leaders for handling complaints and grievances.

This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Required Minimum Education: 2 Year/ Associates Degree

Specialty/Major: Business or Healthcare Services

Preferred Education: 4 year/ Bachelor’s Degree

Specialty/Major: Healthcare Administration or Business Management

Minimum Years and Type of Experience : 1 - 3 years healthcare experience and demonstrated customer service skills; familiarity with CMS and other managed care insurance management programs or complaint/investigation department.

Other Knowledge,

Skills and Abilities

Required
:
Excellent communication skills; with ability to collaborate and communicate sensitively and respectfully. Demonstrate professionalism and leadership.

Other Knowledge, Skills and Abilities Preferred: A…