Job Description
Job Description Work Status Details: REGULAR FULL TIME | 80.00 Hours Every Two Weeks
Shift: Varied
Pay Rate Type: Annual Salary
Location: Yuma Medical Center
Listed is the base hiring salary range offered for this position. Actual salaries may vary depending on factors, including but not limited to skills and experience. The salary range listed is just one component of the total rewards/compensation package offered to candidates.
Min = $91,359.84
Mid = $118,767.80
Max = $146,175.75
Summary The Patient Experience Service Review Manager, RN will play an active role in investigating and resolving complaints and grievances to maintain the highest levels of patient care. This position aligns for someone who is a clinically adept problem-solver who thrives in dynamic, fast-paced settings. This position is committed to enhancing healthcare through comprehensive investigation, resolution, and collaboration with teams, providers, and leaders. This position will help manage the grievance process and support care advocacy initiatives to ensure compliance with CMS and DNV standards. The Service Review Manager will also utilize their knowledge to evaluate complaint allegations and engage with cross-functional stakeholders to drive effective resolutions and ensure timely and effective resolution of care concerns. This role will also monitor grievance trends, track Key Performance Indicators (KPIs), and apply data-driven insights to enhance quality of care delivery, improve patient experience, and support organizational reputation. This role will supervise the Patient Ex perience Care Advocate Specialists.
Responsibilities Grievance Process Management: - Supports grievance management process from intake through resolution, ensuring all Supports grievance management process from intake through resolution, ensuring all grievances are documented, tracked, and resolved within CMS and DNV regulatory timelines.
- Manages complex or escalated grievances, ensuring timely and effective resolution in alignment with organizational goals and regulatory requirements.
- Monitors grievance data and trends to identify recurring issues and areas for process improvement.
- Maintains accurate and detailed records of all grievances, appeals, and resolutions.
- Ensures resolution are in accordance with regulatory requirements, organizational policies, and best practices
- Leads and supervises the Experience Care Advocate Specialists ensuring effective management and support.
Grievance Committee Support - Co-facilitate grievance committee meetings, ensuring comprehensive review and resolution of grievances and appropriate action.
- Prepares reports, presentations, and case materials for the grievance committee to ensure timely and well-informed decision-making.
- Ensures that all committee decisions align with CMS, DNV, and organizational policies, and communicate outcomes clearly to patients and relevant stakeholders.
Collaboration and Communication - Collaborates with other departments, such as clinical teams, quality improvement, and administration, to address patient concerns and ensure resolution.
- Works closely with the Patient Experience team to develop strategies for enhancing patient experience based on review data.
- Communicates effectively with patients, both in writing and over the phone, to acknowledge feedback and inform them of any follow-up actions.
- Serves as a liaison between patients, families, and various departments to ensure that concerns are addressed quickly and appropriately.
- Addresses complex or high-stakes grievances or care concerns, demonstrating strong problem-solving and conflict resolution skills.
Data Analysis And Reporting - Collects and analyzes grievance-related data to identify trends and measure performance against qualitative insights and quantitative data monitoring and tracking Key Performance Indicators (KPIs).
- Provides data-driven insights on grievance trends, patient care outcomes, and care advocacy efforts to senior leadership.
- Reports on grievance metrics, including resolution time to ensure continuous improvement.
Compliance, Privacy, Continuous Improvement - Ensures all patient reviews and communications are handled in compliance with HIPAA and other relevant privacy regulations.
- Maintains confidentiality and security of patient information at all times.
- Regularly evaluate the grievance management process to ensure compliance with CMS, DNV, and other applicable regulations. Identifies opportunities for process improvement based on grievance trends, patient feedback, and internal audits.
- Stays updated on changes in CMS, DNV, and other relevant regulations to ensure ongoing compliance with grievance handling standards.
Training And Education - Supports training sessions for staff on grievance management processes and CMS/DNV compliance requirements.
- Creates educational materials and resources to enhance staff understanding of grievance procedures and the importance of patient advocacy. Fosters a culture of proactive care advocacy and patient-centered care throughout the organization.
Reviewing Patient Medical Records - Reviews patient medical records as part of the grievance investigation process to gather relevant information and provide evidence-based findings.
- Utilizes clinical knowledge to assess the accuracy and quality of care provided and ensure that grievance cases are resolved with appropriate medical evidence.
- Documents and present findings based on patient records, ensuring that decisions are backed by clinical facts and align with evidence-based practices.
Credentials Other duties as assigned Essential Education Essential:
Other Information Minimum Requirements: Associate degree in Nursing or Clinical Degree required (bachelor’s degree preferred)
Active Registered Nurse (RN) License
Certification in healthcare quality or compliance (e.g., Certified Professional in Healthcare Quality - CPHQ) preferred
Minimum of 2 years of experience in patient experience, quality, or grievance management within a healthcare setting.
Experience working with CMS and DNV compliance standards is preferred.
Experience With Epic And Midas Platforms Is Preferred. Prior exposure to patient relations or quality improvement is preferred .
Join us at Yuma Regional Medical Center dba Onvida Health A career at Onvida Health is more than just a job. It’s a place to have a long and rewarding career, making a difference in the lives of those in our shared community. When you join our team, you become an integral part of a thriving community committed to improving the health and well-being of everyone in southwestern Arizona.
At Onvida Health, we believe in progress with purpose. Our commitment to innovation is matched by our dedication to kindness and integrity. We take our values seriously because we know they lead to better outcomes for our patients and a better experience for all of us. We’re looking for people who approach each day with a sense of possibility, a drive to make things better, and a commitment to kindness. If that sounds like you, you’re our kind of people.
If you’re looking for a career where innovation meets compassion, where you can grow and contribute to building a healthier tomorrow, Onvida Health is the place for you.
Life in Yuma, Arizona
Yuma, recognized by Guinness World Records as the Sunniest City on Earth, offers more than just sunshine. It’s a place where the great outdoors meets a welcoming, tight-knit community. Hike scenic trails, explore the Colorado River, or immerse yourself in local cultural festivals - all while embracing the beauty of this desert oasis. With easy access to larger cities and popular destinations, Yuma makes it easy to balance a fulfilling career with time for personal adventures and relaxation.
Physical Requirements and working conditions for this position will be provided to you up on interview.
Job Tags
Full time, Local area, Outdoor, Shift work,