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Exemption Status:

Non-Exempt

Schedule Details:

Monday through Friday

Scheduled Hours:

8a-430p

Shift:

1 - Day Shift, 8 Hours (United States of America)

Hours:

40

Cost Center:

10030 - 6201 Office Of Patient Advocacy

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Job Title:  Manager Patient Advocacy                     

Job Profile Summary:

The Manager of Patient Advocacy works under the direction of the Director of Advocacy & Development and is responsible for all patient advocacy efforts. Serves as a liaison between patients/patients’ families and UMMMC caregivers. Ensures review, response, and remediation to all UMMMC complaints regarding patient care and experience in accordance with hospital/system policies. Oversees patient grievances and medical reviews for UMMMC. Employees in the Office of Patient Advocacy report directly to the Manager.

The focus of the role is on supporting patient’s rights, advocating for patient/family needs, and facilitating the resolution of patient/family concerns.  

Major Responsibilities: Oversight of all grievance reviews and assists the clinical patient advocates in coordinating the cases with physician quality officers, nursing leadership, hospital leadership, quality, and risk management. Coordinates the weekly UMMMC grievance meeting and collaborates with the Chief Quality Officer to meet the regulatory standards. Responsible for coordinating appeals that come into the Medical Center pertaining to patient care. Responsible for coordinating the follow through on all health insurance grievances in a timely manner. Responsible for training and education for the physician quality officers related to medical reviews and grievances. Responsible for the maintenance of SI-COM and implementing any improved changes.  Ensures incoming complaints are triaged (ie: answered, assigned, investigated, and responded to) in a timely and empathetic manner.  Ensures cases are documented completely and timely; works with database to ensure efficiency.   Provides leadership with a timely understanding of the trends and themes in complaints, as identified through data analysis, and suggestions on improvement areas across the organization. Focuses office’s efforts equally on proactive prevention of complaints and reactive response to complaints.  Advises colleagues on appropriate responses to complaints.   Responsible for ensuring regulatory compliance regarding complaints/grievance process.    Independently rounds on patients/families/staff, and as requested by leadership. Collaborate throughout hospital to help improve the patient experience. Daily identification of areas in the organization that needs focused support from the department. Responsible for continuously optimizing the efficiency of the Office of Patient Advocacy. Works with Patient Advocates and leadership to determine ideal process flow for the Office of Patient Advocacy. Develops and oversees process to ensure complaints are triaged accurately among patient advocates, risk management, Associate Chief Medical Officer/Chief Medical Officer, and other internal departments as appropriate. Primary liaison with the Risk Management department and responsible for ensuring aligned, accurate, and complete communication at all times. Coordinates efforts with Legal Counsel, Public Relations, Regulatory Affairs, etc.  Collaborate with Director of Advocacy & Development to develop department goals; responsible for establishing individual goals for staff. Provides report to the Patient Care Assessment committee, annually and as requested. Participates on committees or process improvement teams to improve that patient experience by providing knowledge from their work. Continuously enhances professional job-specific knowledge by participating in internal and external educational opportunities; reading professional publications; participating in professional organizations. 

Standard Management Level Responsibilities: 

1.            Directs and supervises assigned personnel including performance evaluations, scheduling, orientation, and training. Makes recommendations on employee hires, transfers, promotions, salary changes, discipline, terminations, and similar actions. Resolves grievances and other personnel problems within position responsibilities.

2.            Develops and recommends the budgets for the areas managed. Manages activities to assure financial goals are met.

3.            Coordinates the assignment of tasks and helps resolve technical and operational problems. Evaluates the impact of solutions to ensure goals are achieved.

4.            Provides effective direction, guidance, and leadership over the staff for effective teamwork and motivation; and fosters the effective integration of efforts with system-wide initiatives.

5.            Encourages and supports diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, respect, tolerance, civility and acceptance toward all employees, patients, and visitors.

6.            Integrates diversity into departmental objectives, such as hiring, promotions, training, vendor selections, etc.

7.            Participates in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.

8.            Ensures compliance with regulatory agencies such as Joint Commission, DPH (Department of Public Health), etc. Develops and maintains procedures necessary to meet regulatory requirements.

9.            Ensures that department complies with hospital established policies, quality assurance programs, safety, and infection control policies and procedures.

10.          Ensures adequate equipment and supplies for department.

11.          Develops and maintains established departmental policies, procedures, and objectives.

12.          Ensures compliance to all health and safety regulations and requirements.

13.          Maintains, regular, reliable, and predictable attendance.

14.          Performs similar or related duties as required or directed. All responsibilities are essential job functions.

II. Position Qualifications:

License/Certification/Education:

Required:

Master’s Degree in health-related field.

Preferred:

Licensed Independent Clinical Social Worker.  

Experience/Skills:

Required:

Five years of clinical experience within their licensed field. Minimum of one year previous management experience. Two-three years of experience with working with patient grievances and complaints.  Two years of experience of conducting a medical review and sending a formal grievance letter. Experience with organizing and leading crucial family meetings with hospital leadership that pertain to a grievance. Experience with case review including root cause analyses or having been in a position to evaluate quality of care (optimally, nursing and medical). Excellent written and verbal communication skills.  Ability to write clinically sound letters and/or review/edit/revise letters written by the patient advocates. Working experience and continued familiarity with top organizational issues that result in complaints. Example:  ED waiting/boarding, pain management, handoff communication and communication within multidisciplinary teams, etc. Strong data analytics – ability to analyze and synthesize complaint/grievance data; use data to identify and address themes and trend; provide guidance on areas of improvement. Significant experience with data driven process improvement. Ability to form and maintain strong working relationships with other hospital stakeholders (ex: doctors, nurses, administrators, Risk, Legal, social workers, case managers, etc) to aide process of complaint identification and resolution. Familiarity with large healthcare organizations specifically clinical roles, and processes to aide in utilizing the best/fastest ways to get the complaint-response work done. Outstanding organizational skills leveraging technology to store, track, retrieve data. Takes initiative to find new and better ways to leverage Safety Intelligence (safety occurrence reporting system). Epic, and other electronic platforms to improve our work and service to our patients. Proficient in all basic computer skills.

Preferred:

Experience with patient safety and healthcare QI—Lean training.

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

III. Physical Demands and Environmental Conditions:

Work is considered sedentary. Position requires work indoors in a normal office environment and patient care environments.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.