Patient Risk Relations Specialist

Southern Illinois Healthcare; Carbondale (IL); On-site; USD 69,000 - 107,000; Full time

Job summary

Southern Illinois Healthcare is seeking a Nurse leader to manage patient relations grievances and risk events within CMS guidelines. You will de-escalate highly emotional situations, coordinate with medical staff, and drive service recovery across departments.

Role emphasizes independent work, mentorship, and ongoing professional development while aligning with hospital risk management and quality initiatives.

Qualifications

• Associates Degree in Nursing required.
• Bachelor’s degree in Nursing preferred.

Responsibilities

• Directly responsible for patient complaints/grievances via multiple channels (face-to-face, letters, calls, emails, surveys).
• Investigate concerns in collaboration with administration, providers, managers and supervisors.
• Facilitate grievance meetings and act as patient liaison; ensure timely and satisfactory resolutions.

Skills

Patient relations

De-escalation

Risk analysis

Communication

Mentorship

Independent work

Staff supervision

Education

Associate Degree in Nursing

Bachelor’s degree in Nursing preferred

Job description

Current SIH employees need to apply for positions through our internal job portal. Log in to Workday to apply through the Jobs Hub.Position SummaryResponsible for managing patient relations grievances and/or complaints. Assist in identification, evaluation, and treatment of risk events within the hospital to reduce the frequency and severity of controllable unusual events, which may result in injury to patients or financial loss to the institution within the framework of the goals, objectives, and mission of SIH.EducationAssociates Degree in Nursing requiredBachelor’s degree in Nursing preferredLicenses and CertificationCurrent Illinois RN LicensureExperience and SkillsTechnical Experience: 5 yearsMay supervise staff intermittently in absence of ManagerAbility to manage highly complex and uniquely challenging situations, requiring extensive consideration of variables that impact multiple areas outside of the job area.Ability to work independently with little supervision and provide general guidance, mentorship, or indirect supervision to colleagues.Ability to de-escalate highly emotional and intense situations with patients/families, providers, and colleaguesRole Specific ResponsibilitiesPatient Relations (35%)Directly responsible for specific patient complaints/grievances in the form of face-to-face patient and family contact, letters, phone calls, emails, patient satisfaction surveys, and potentially other forms of communication (e.g. provider or employee communication);Directly responsible for Investigating concerns through collaboration with a dministration/Providers/Managers/Supervisors for timely responses to patients/families.Facilitates grievance meetings and acts as patient liaison.Directs patient inquiries and complaints to appropriate medical staff members and follows up to ensure satisfactory resultions.Explains policies, procedures, and services to patients using medical or administrative knowledge.Directly responsible for resolving the patient/family concern(s) in a formal written follow-up process within CMS guidelines.Assists with managing billing concerns related to patient/family complaint/grievance at the guidance of the facility Risk Manager.Directly responsible for collaborating with all levels of the organization to investigate patient lost belongings.Initiates the re-imbursement process for replacement when warranted.Facilitates service recovery as specific occasions arise.Reads literature, talks with colleagues, continues education, and participates in professional organizations or conferences to keep abreast of developments in the field. Identifies and shares research, recommendations, or other information pertinent to patient/family satisfaction.Risk (65%)Directly responsible for reviewing/monitoring risk events in the monitors RDE (Remote Data Entry) reporting system.Directly responsible for investigating risk concern through chart reviews and collaboration with the Medical Staff members and staff.Directly responsible for managing communication with patients/families to ensure transparency, timeliness, and resolution.Identifies potential risks by analyzing data, observing processes, and talking to providers and staff.Ensures and/or facilitates adequate communication concerning key risks.Collaborates with Quality Peer Review Coordinator when cases are identified as potential peer issues.Responsible for timely referrals to Infection Prevention, Quality, Nursing, Ancillary Departments, Administration, and other departments as appropriate.Reviews patient charges for any pertinent adjustments and monitors for the completion of adjustments.Supervises office staff when manager is unavailable or otherwise engaged.Directly responsible for new provider orientation.Performs general employee and Nursing orientation.Assists with external requests for explants.Reads literature, talks with colleagues, continues education, and participates in professional organizations or conferences to keep abreast of developments in the field. Identifies and shares research, recommendations, or other information pertinent to legal liabilities, risk management or quality of care.Compensation (Commensurate with experience):$68827.2To$106683.2To access our Benefits Guide/Plan Information, please click the link below:http://www.sih.net/careers/benefits