Patient Relations Consultant
Company: Cambridge Health Alliance
Posted on: September 22, 2022
Location: CHA East Cambridge Care CenterWork Days: 8-4:30
M-FCategory: Professional and ManagementDepartment: CHA PACEJob
Type: Full timeWork Shift: DayHours/Week: 40.00Union: NoUnion Name:
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.
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
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
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
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
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
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
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
Requires excellent interpersonal skills with individuals in crisis,
including populations with mental health illness and/or substance
Requires skills in working with teams to achieve goals.
Requires excellent negotiation skills in a diverse and
Requires a high level of sensitivity to confidential
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
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
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
Keywords: Cambridge Health Alliance, Cambridge , Patient Relations Consultant, Professions , Cambridge, Massachusetts
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