Job Details

Manager, Patient Care Grievances- Office of the Vice President for Legal Affairs

Job Number: 527282
Categories: Professional
Location:
Dallas, TX

Department: Ofc of VP Legal Affairs
Full/Part Time/PRN: Full-Time
Regular/Temporary: Regular



Security


This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information


Salary


Salary Negotiable 


Experience and Education


Bachelor degree in related field and at least five (5) years progressively responsible, related experience to include at least three (3) years in supervisory capacity; or, ten (10) years in healthcare administration of legal/risk matters with progressive responsibility.

Job Duties


1.Coordinate with Patient Assistance Office the identification and assignment of complaints as service complaints to be handled by the Patient Assistance Office or quality of care complaints to be handled by Medical Risk Management.
2.Refer to Patient Assistance Office complaints that are solely related to service and billing matters.
3.Oversee triaging of quality of care complaints handled by Medical Risk Management to identify those that meet the regulatory criteria of a Grievance, as defined by Centers for Medical Services and Joint Commission, to ensure that appropriate responses are timely prepared.
4.Triage elements of patient care concerns that need review by patient safety, billing compliance, privacy or other offices within UT Southwestern. Integrate feedback into response to be given to patient.
5.Responsible for all UT Southwestern responses to patient complaints about care provided at any location staffed by UT Southwestern providers.
6.Ensure compliance with regulatory requirements pertaining to patient grievances. Develop and provide relevant data to assist with CMS or Joint Commission surveys and investigations. Facilitate CMS and TJC regulatory staff access to information about patient grievance process. Respond to investigator's questions.
7.Organize and direct agenda for the hospital Grievance Committee. Ensure representation and participation by appropriate hospital personnel.
8.Responsible for provision of summary information and reports to the Professional Liability Committee and Hospital Board.
9.Ensure that concerns entered into service recovery reporting database are clearly stated for review by risk managers. Clarify as needed through verbal communication with the patient. Determine if complaint can be addressed informally. Resolve complaints that do not require formal response or that can be addressed quickly, either by immediate assistance or by referral to appropriate UT Southwestern offices.
10.Assign review of care complaints to risk managers and coordinate obtaining of information from ancillary offices to assist with complaint resolution.
11.Provide assistance to risk managers when time is of the essence to receive investigative responses from clinical providers, medical directors or other offices within UT Southwestern.
12.Write/ edit responses to complaints. Seek approval by hospital executive leadership and provide final response to patients for hospital complaints. Coordinate with executive leadership for responses to ambulatory complaints.
13.Handle calls from patients dissatisfied with the University's final response. Re-open file when new complaint is raised by patient.
14.Track and trend complaints about care to provide feedback to clinical leadership. Identify trends that need to be addressed. Work with clinical providers and risk management staff to recommend and/or implement changes.
15.Respond to UT System offices regarding complaints received at UT System about care provided at UT Southwestern.
16.Coordinate consistent complaint responses with our affiliated hospitals.
17.Oversee patient termination process to ensure terminations are in accordance with University policies and Texas Medical Board rules and regulations. Handle patient calls referred by clinics of patients who dispute termination.
18.Handle calls referred from clinics from patients dissatisfied with providers' decisions to discharge the patient from the clinical practice.
19.Handle calls referred from clinics transferring patients dissatisfied with physician decisions. Address risk of specific situations with risk management attorneys and refer as needed to supervising attorneys.
20.Investigate and resolve patient complaints as needed.
21.Assess and seek approval from executive leadership of billing adjustments when appropriate.
22.Review, develop and recommend improvements in the University's process of responding to patient care complaints.
23.Work with risk managers to identify and refer significant concerns about care to UT Southwestern Professional Liability Committee for in depth assessment.
24.Supervise and provides direction to risk managers/staff responding to patient complaints and administrative staff supporting this job function.
25.Supervise and provide direction to administrative staff member who coordinates patient termination process.


**Other Duties:  Performs other duties as assigned. 

UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; gender, including sexual harassment; age; disability; citizenship; and veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.

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