Patient Grievance and Relations Specialist

oumedicine; Oklahoma City (OK); On-site; USD 60,000 - 90,000; Full time

Job summary

OU Medicine in Oklahoma City seeks a Patient Grievance and Relations Specialist II to support system-wide patient experience initiatives. You will assist with service recovery, investigation, and timely response to complaints across modalities, partnering with leadership to improve safety and patient satisfaction.

The role emphasizes documentation, data entry into Patient Relations software, and collaboration with care teams to resolve grievances while upholding regulatory timelines.

Qualifications

• Supports daily operations of the Patient Relations team.
• Reviews and escalates complaints as needed.
• Uses Patient Relations software to track trends.
• Communicates with leadership to identify areas for improvement.

Responsibilities

• Field patient and visitor complaints across modalities.
• Review files and escalate to grievances when needed.
• Provide service recovery and de-escalation.
• Ensure timely acknowledgements and resolution letters.
• Document complaints and input data into software.
• Collaborate with leadership and stakeholders to resolve issues.

Skills

Patient relations

Regulatory compliance

Communication

Investigations

Data entry

Tools

Patient Relations software

Job description

Position Title:

Patient Grievance and Relations Specialist

Department:

Patient Experience

Job Description:

The Patient Relations Specialist II provides support for all components of the system-wide patient and visitor quality and experience program by incorporating high reliability principles into daily work that drives an effective patient relations program. Assists leadership and coworkers on the Patient Relations team to support Department of Patient Experience efforts system wide. Serves as a subject matter expert with service recovery, documentation, investigation, and resolution of patient and visitor complaints system wide. Actively participates in the pursuit and accomplishment of department goals and initiatives to ensure regulatory compliance is met regarding the timely and effective response to patient and visitor complaints and grievances with OU Health. Advocates for and nurtures a system-wide culture of safety for patients, workforce members, providers, and visitors through direct interactions.

Essential Responsibilities:

• Supports the daily operations of the Patient Relations team, including fielding patient and visitor complaints received in all modalities.
• Reviews daily files submitted into Patient Relations software for complaints needing attention or review by the Patient Relations team. Analyzes files not submitted by the Patient Relations team to determine if a submitted file should be escalated to a grievance from a complaint and initiates actions as appropriate.
• Provides service recovery and de-escalation techniques to assist complainants navigate their right to file a complaint with our health system.
• Maintains a team approach to support compliance with regulatory guidelines and timelines as outlined by policy with the timeliness of acknowledgement and resolution letters for patient grievances.
• Composes and mails letters to patients or their representatives including grievance acknowledgements, grievance resolution, valuables reimbursement, and other written communications as needed.
• Inputs data into Patient Relations software to ensure accurate data on trends of feedback received.
• Communicates effectively with leadership to support the identification of areas requiring additional focus by monitoring active trends based on locations, volume, types of concerns communicated, and effectiveness of responses to complaints input into the software.
• Conducts and guides investigations into grievances including guidance to unit leadership, interviewing personnel involved, chart reviews, and hold debriefing sessions as needed.
• Conducts reviews of concerns and determines if additional escalations are required from the complaint including but not limited to the Department of Patient Safety and Regulatory, Ethics and Compliance referral, Human Resources referrals, and service line executive leadership referrals.
• Appropriately follows policy for escalating allegations of abuse, assault, and neglect to applicable stakeholders or law enforcement as needed.
• Maintains a working relationship with Legal and Claims services to manage risk around complaints and grievances.
• Works collaboratively with all levels of system-wide stakeholders to resolve and report out complaints and grievances.
• Serve on committees as needed as a subject matter expert.
• Participate on teams providing recommendations regarding billing adjustments based on working knowledge of specific cases and patient experiences identified in these cases.
• May be called to support Patient Relations leadership with the preparation, running, and scribing of the OU Health Complaints and Grievances Committee.
• Advocates for patients and visitors' requests for assistance or concerns through effective communication with all appropriate levels of OU Health personnel in an impacted area or healthcare team.
• Effectively collaborates in a professional and respectful manner by making recommendations that will help support resolution of a situation.
• May be called to serve on a team or committee as a subject matter expert regarding appeals by patients challenging dismissal from clinical practices.
• Maintain compliance with OU Health policy on flu vaccination and TB testing as applicable.
• Clearly and effectively documents a patient or visitor complaint by making every effort to capture the concern from the perspective of the complainant and taking their voice forward in good faith.
• Maintains working knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the Patient Relations team.
• Follows internal controls and processes designed to promote adherence with applicable laws, accrediting agency requirements, and federal, state, and private health plans. Escalates concerns or recommendations in a timely manner to appropriat