Diverse Lynx
Non-Clinical - Administrative/Quality Assurance Analyst
Diverse Lynx - San Francisco, California, United States, 94199
Work at Diverse Lynx
Overview
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Overview
Job Description & Responsibilities:
The Grievances & Appeals Specialist plays a critical role in supporting patients and families by investigating complaints, concerns, and feedback received by the organization. The responsibilities include:
Investigating patient/family complaints related to care quality, physician/provider actions, Sutter Health policies, and potential liability. Handling highly complex and conflict-heavy cases, requiring innovation and collaboration across departments. Working closely with managers, physicians, and staff to resolve patient grievances. Coordinating with Legal and Risk Management on medical-legal matters. Providing crisis intervention and mediation for complex institutional concerns. Conducting case investigations, including interviews with patients/families, medical record reviews, and policy/procedure evaluations. Facilitating case conferences and working with leadership to implement corrective action plans for quality improvement. Ensuring compliance with CMS Conditions of Participation and Sutter Health grievance policies. Maintaining a patient and family-centered approach, prioritizing transparency and resolution at the most appropriate levels. Managing a high caseload and ensuring timely documentation to meet regulatory timelines. Qualifications & Skills: Education: Bachelor's degree in Business Administration, Nursing, Social Work, or another healthcare-related field, or equivalent education/experience. Experience: Minimum 2 years of recent relevant experience in grievances, appeals, or patient advocacy. Skills Required: Strong oral and written communication for composing patient responses and synthesizing investigation findings. Analytical skills for medical record reviews, quality-of-care investigations, and patient safety concerns. Case management expertise, handling high volumes while ensuring timely compliance. Conflict resolution and problem-solving in a high-stakes, fast-paced healthcare environment. Technical proficiency in word processing, email, database management, and patient care software. Cultural competence and ability to navigate sensitive diversity-related concerns. Autonomy and resourcefulness in handling complex grievance cases.
Investigating patient/family complaints related to care quality, physician/provider actions, Sutter Health policies, and potential liability. Handling highly complex and conflict-heavy cases, requiring innovation and collaboration across departments. Working closely with managers, physicians, and staff to resolve patient grievances. Coordinating with Legal and Risk Management on medical-legal matters. Providing crisis intervention and mediation for complex institutional concerns. Conducting case investigations, including interviews with patients/families, medical record reviews, and policy/procedure evaluations. Facilitating case conferences and working with leadership to implement corrective action plans for quality improvement. Ensuring compliance with CMS Conditions of Participation and Sutter Health grievance policies. Maintaining a patient and family-centered approach, prioritizing transparency and resolution at the most appropriate levels. Managing a high caseload and ensuring timely documentation to meet regulatory timelines. Qualifications & Skills: Education: Bachelor's degree in Business Administration, Nursing, Social Work, or another healthcare-related field, or equivalent education/experience. Experience: Minimum 2 years of recent relevant experience in grievances, appeals, or patient advocacy. Skills Required: Strong oral and written communication for composing patient responses and synthesizing investigation findings. Analytical skills for medical record reviews, quality-of-care investigations, and patient safety concerns. Case management expertise, handling high volumes while ensuring timely compliance. Conflict resolution and problem-solving in a high-stakes, fast-paced healthcare environment. Technical proficiency in word processing, email, database management, and patient care software. Cultural competence and ability to navigate sensitive diversity-related concerns. Autonomy and resourcefulness in handling complex grievance cases.