JOB SUMMARY Directly reports to the BHS Director, Risk Management. Under the guidance of the BHS Director of Risk Management, the Patient Representative/Risk Analysist will work as part of the Risk Management team to further Beacon Health System’s goals to reduce, mitigate, and strive to eliminate harm to patients and visitors, while protecting the interests of the health system. The Patient Representative/Risk Analyst functions as the administrative representative for patients, patient’s their families, or visitors who have complaints or grievances, concerns or questions regarding the services provided by Beacon Health System entities. Serves as a risk management resource and centralized hub for all leadership, associates, and providers at all Beacon Health System entities. Assists in identifying problems, facilitating solutions, and is a conduit for communications through to the resolution of issues. Utilizes investigational/research and non-judgmental skills to mitigate and resolve issues. Performs and/or assists in the investigation of incidents and/or lost/missing/broken items throughout the hospitals and offices. Serves as an expert resource for entry of information the electronic incident/complaint system for all leadership and associates. Can provide additional education as necessary. Ensures the Director of Risk Management or appropriate leadership are aware of patient issues/concerns, any potential compensable events, and any recommended process changes through the collection and analysis of data, and provides summary reports as needed.
MISSION & VISION Mission: To enhance the physical, mental and emotional well-being of the communities we serve as the community’s provider of outstanding quality, superior value and comprehensive health care services. Vision: Our vision is to achieve:
Innovative health care and well-being services of the highest quality at the greatest value
Easy access and convenience
Outstanding patient experiences
Ongoing education involving physicians, patients and the community
JOB SPECIFICATIONS Education and Experience The knowledge, skills and abilities as indicated below are normally acquired through successful completion of a Bachelor's Degree in a health related field or business. Preference of one to three years of one or more of the following: patient relations, advocacy, ombudsman, case management, or social work experience in a health care setting. Training or experience in conflict management or de-escalation techniques preferred. Knowledge of medical terminology preferred.
Knowledge & Skills 1. Preferable knowledge of how the healthcare business functions, how patient care is delivered and what types of patient problems exist in a hospital or outpatient environments to evaluate and understand interpret clinical information. 2. Demonstrates well developed communication skills, orally and in writing, to enable strong interpersonal interaction and communicate sensitive issues with patients, family, physicians, Beacon associates, providers, and administration. 3. Requires a high level of non-judgmental, analytical, and problem solving skills to evaluate patient/family requests, concerns, and incidents through to resolution. Utilizes excellent listening, and verbal and written communication skills. 4. Demonstrates the ability to do research and review a medical record and glean information to make decisions based on facts. 5. Demonstrates a high degree of independence, integrity, accountability, confidentiality, and good listening skills in responding to the requests of patients, while also protecting the entity’s reputational, financial, and customer service interests. 6. Demonstrates a high level of knowledge of the dynamics customer service and service recovery techniques. 7. Demonstrates the ability to provide a variety of risk management related information and education to associates as needed. 8. Requires ability to maintain strict confidentiality of all information utilized within department. 9. Demonstrates knowledge of and a commitment to Beacon Health System's mission and values and the organization's and department’s goals.
Working Conditions 1. Works in an office and patient care environment. 2. May need to work during an early morning, evening and/or weekend as determined by department or organizational needs. 3. Ability to travel as needed. Physical Demands 1. Requires the physical ability and stamina to perform the essential functions of the position.
ESSENTIAL JOB DUTIES The below statements are intended to describe the essential job functions and level of work performed by individuals assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by the personnel occupying this position. 1. Represents Beacon administration to patients, patient’s families, or visitors who have complaints, concerns or questions regarding services provided at Beacon Health Systems, and assists in coordinating or directly working on Incidents that happen at all locations by:
Interpreting and representing Beacon Health Systems' philosophy, policies, procedures, and patient rights and responsibilities.
Assisting in referring patients to appropriate services and resources, in cooperation with existing hospital or office leadership, and responding when alternatives are not available.
Providing patients and families with amenities, credits on accounts, and/or access to administration, Director of Risk Management, or other appropriate leader.
Providing assistance to leadership by handling patient/family issues brought directly to administration or corporate offices.
Documenting complaints/grievances in details within the established electronic system(s).
Writing appropriate response letters with established guidelines/templates, and timelines.
Working with leadership to provide assistance and follow up on incidents that occur within the hospital, physician offices, or other Beacon entities.
Intervening with patients and/or their families who are demonstrating disruptive behavior, as needed.
Assisting to develop/adapt risk management related policies and procedures.
Assisting in providing education and/or orientation programs to enhance BHS's commitment to customer service and service recovery, patient rights and responsibilities, or other pertinent medical-legal issues.
2. Performs Risk Analyst functions by:
Completing professional financial account auditing, medical record review, on-line research, or pulling together other sources of information as necessary to determine the accuracy of and appropriateness of services rendered.
Collecting data and channeling patient care concerns to appropriate departments and services to initiate recommendations of change in BHS procedures and policies or other processes, if appropriate.
Participating in the assessment of responses to incidents and/or lost/missing/broken items. Intervening appropriately to eliminate serious controversy and/or legal problems in coordination with the BHS Director of Risk Management.
Developing, implementing and maintaining requested/required records, reports, statistics, etc. Assist in providing recommendations to reduce predominant trends.
Assisting in providing guidance for all associates when working with the electronic Incident Reporting system.
Provides education on this system as needed.
3. Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by: Promoting the establishment and maintenance of meaningful relationships with BHS associates, leadership, and providers to ultimately enhance interdepartmental/facility effectiveness. Demonstrates the ability to work at/with other Beacon locations, and can work interchangeably for another Patient Representatives/Risk Analysist(s) as needed. Completing other job-related assignments and special projects as directed.
STANDARDS OF BEHAVIOR Patient/Customer Centered Anticipates and takes proactive steps to ensure customer’s needs are met Places courtesy and service above routine and goes beyond customer expectations Keeps patient/work environment neat and clean Understands and applies job-related aspects of patient safety and identifies, reports and corrects safety concerns as quickly as possible Respect Keeps others well informed Practices active listening Develops and maintains positive working relationships Uses problem solving techniques to resolve issues and makes decisions within personal sphere of influence Seeks to understand patient's experience Integrity Demonstrates integrity and strong business ethics Utilizes time and resources in a prudent manner Strives to continually improve department processes and services Projects professional image through enthusiasm towards work, behavior and appearance Compassion Demonstrates Beacon values verbally and through actions Displays and exhibits caring behaviors with each interaction Demonstrates self-awareness and sensitivity to the perceptions of others Listens carefully to input and concerns and takes appropriate action Interacts with dissatisfied customers in a calm, respectful manner and seeks resolutions Trust Maintains confidentiality at all times Fosters a sense of trust and collaboration among associates Verbal and written communications are clear and effective Responds to change in a positive manner
ORGANIZATIONAL RESPONSIBILITIES Associate complies with the following organizational requirements:
Attends and participates in department meetings and is accountable for all information shared.
Completes mandatory education, annual competencies and department specific education within established timeframes.
Completes annual employee health requirements within established timeframes.
Maintains license/certification, registration in good standing throughout fiscal year.
Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
Adheres to regulatory agency requirements, survey process and compliance.
Complies with established organization and department policies.
Available to work overtime in addition to working additional or other shifts and schedules when required.
Commitment to Beacon's six-point Operating System, referred to as The Beacon Way:
Leverage innovation everywhere.
Cultivate human talent.
Embrace performance improvement.
Build greatness through accountability.
Use information to improve and advance.
Communicate clearly and continuously.
Patient Representative/Risk Analysis is an important position that serves as a patient advocate and corporate advisor when dealing with risk management concerns, such as patient incidents and complaints.
This candidate needs to be able to deal with difficult patients or visitors situations with sensitive circumstances, as well as, assist staff in coordinating risk mitigating efforts.
This candidate should be able to do research, review and understand a medical record, and be personable, professional and trustworthy.