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Job Details

Patient Relations Consultant

Date Posted: 07/11/2022

Requisition Number: 2607

Location: CHA East Cambridge Care Center

Work Days: 8-4:30 M-F

Category: Professional and Management

Department: CHA PACE

Job Type: Full time

Work Shift: Day

Hours/Week: 40.00

Union: No

Union Name: Non Union


CHA PACE is a Program of All-Inclusive Care for the Elderly (PACE) at Cambridge Health Alliance (CHA). CHA PACE serves adults 55 years and older with chronic medical and/or mental health difficulties with the goals of achieving the highest level of community independence and preventing nursing home placement. CHA PACE's high functioning interdisciplinary team works to fully integrate and coordinate medical and behavioral health care, community resources, and in-home support services.


The PACE Quality Improvement team serves as a resource center to the organization to cultivate a culture of safety, eliminate preventable harm for all patients and staff, provide high value, equitable, evidence-based care, create an excellent care experience and to develop institutional capacity in improvement science and promote data-driven decision-making. Join our talented team to contribute towards the mission of our organization.

Responsibilities:

Under the supervision of the PACE Compliance and Quality Manager, conduct timely investigations and response to all patient concerns/complaints/grievances for PACE including interviewing staff and reviewing medical records. Facilitates effective communication between patients, families and providers to enhance patient/family-centered care and ensure common goals. Negotiate and mitigate expectations to promote satisfaction, ensure quality and safety and minimize the risk of adversarial outcomes.
Responds to requests for intervention to assist in managing difficult patient/family situations. Collaborates with clinical service area management and administrative leadership, frontline staff or other hospital services to provide real-time support and/or improvement strategies to reach effective resolution.
Oversees documentation of information regarding patient and/or staff concerns and requests in the department database and disseminates data to appropriate leadership staff for quality assurance purposes.
Oversees dissemination of specific reports to highlight service areas' opportunities for improvement efforts, including progress, obstacles and trends in compliment/complaint data. Proactively identifies trends in collaboration with clinical and administrative leadership in order to develop strategies to improve quality and satisfaction and reduce risk and liability.
Utilizes data management systems to meet regulatory requirements for CMS and MassHealth for complaint management and resolution processes.
Drafts formal responses on behalf of senior clinical and administrative leadership in writing to patients and families to compassionately relay regret for their perceived poor experience and inform them of how their feedback is being utilized to implement beneficial practice changes. Meet regulatory compliance requirements for CMS for investigating and responding to complaints and grievances consistent with CHA policy and applicable regulations.
Facilitates bimonthly Participant Advisor Committees to obtain preemptive feedback regarding the PACE experience.
Assists PACE program with Annual Participant Satisfaction survey, reviews results, educates participants and staff on results and works with PACE Quality to implement suggestions.
Assists PACE program with Annual HOS-M survey, including assisting participants with completion on an individual level in the adult day health center, congregate housing sites, and private homes if needed.
Provides support to the PACE interdisciplinary teams for all service determination requests. Including identification, adherence to timeline, documentation, and letters of denial. Tracks all metrics related to service determination requests.
Provides support to the PACE interdisciplinary teams for all appeal requests. Including documentation, participant interviews, and letters. Tracks all metrics related to appeals.
Maintains department service standards with particular attention to staff teamwork, communication, cultural respect, and time/priority management.
Works with the PACE Quality Improvement team and various sub-committees, including but not limited to Grievance and Appeals Committee, Audit Committee, Falls Committee, Pressure Ulcer Committee, Comfort Care Committee, Utilization Review Committee, and Complex Care Committee
Assist with CMS data collection, including validation and data cleaning

Serves as a highly visible, energetic champion for identification, management and resolution of patient grievances, service determination requests, and appeals. Will oversee all aspects of intake, follow up, and resolution. Will act as liaison between patients, families and the organization in acknowledging and responding to concerns and requests in a compassionate and supportive manner. Possess strong customer service and interpersonal skills, ability to handle difficult situations constructively and interact with physicians and senior leaders. Excellent written and oral communication skills, knowledge of healthcare environment and regulatory requirements preferred.


Requires Bachelor's degree or its equivalent, with graduate level experience highly preferred, and with at least 5-7 years experience in a healthcare or managed care/PACE setting and 2-3 years of experience acting as consultant with clinical and non-clinical staff conducting training and program implementation. Ability to analyze complaints/grievance trends; prepare and present monthly data reports for senior leaders and department directors.

Requires ability to advocate for patients and families in a complex clinical environment.
Requires excellent interpersonal skills with individuals in crisis, including populations with mental health illness and/or substance use disorder
Requires skills in working with teams to achieve goals.
Requires excellent negotiation skills in a diverse and multicultural environment.
Requires a high level of sensitivity to confidential information.
Requires excellent verbal, written and presentation skills; ability to effectively communicate with all levels of the organization (senior management and physician leadership to front-line staff)
Requires superior organizational skills, with ability to function independently and effectively in a changing environment, develop timelines and meet deadlines, prioritize multiple projects, and manage time effectively.
Requires experience working with data and databases.
High energy and organized individual with strong communications, interpersonal and systems thinking skills. Ability to communicate both oral and written with all levels of personnel.
Able to function effectively, independently, and efficiently in a stressful and dynamic work environment.
Requires experience to train managers and leaders across the alliance on service recovery to improve patient experience of care

In keeping with federal, state and local laws, Cambridge Health Alliance (CHA) policy forbids employees and associates to discriminate against anyone based on race, religion, color, gender, age, marital status, national origin, sexual orientation, gender identity, veteran status, disability or any other characteristic protected by law. We are committed to establishing and maintaining a workplace free of discrimination. We are fully committed to equal employment opportunity. We will not tolerate unlawful discrimination in the recruitment, hiring, termination, promotion, salary treatment or any other condition of employment or career development. Furthermore, we will not tolerate the use of discriminatory slurs, or other remarks, jokes or conduct, that in the judgment of CHA, encourage or permit an offensive or hostile work environment.

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