Service Excellence Officer

Service Excellence Oversight

This position is hybrid, with the option of working from home 2 days / week. Some weeks may require presence 5 days / week in the Pittsburgh, PA or Erie, PA hospital or organization setting.

General Overview : This job is responsible for the oversight and enhancement of all Service Excellence efforts including complaint, grievance, and internal investigations of patient and family concerns. Duties include service recovery and resolution of complaints, management of complaint and grievance process, patient and family advocacy, tracking and trending, reporting and identification of opportunities for improvement in compliance with CMS, Pa DOH, OCR and TJC regulatory requirements. This role also includes facilitating the Patient Family Advisory Council (PFAC) and providing education and training on service excellence best practices.

Essential Responsibilities :

• Effectively triage, investigate, resolve and document complaints and grievances while ensuring adherence to the Patient Bill of Rights, regulatory requirements and network policy Patient Complaints, Grievances and Compliments. Analyze complaints and grievances data and report trends and / or patient feedback to designated committees and teams. Serve as the designated Grievance Officer, fulfilling regulatory requirements for handling patient grievances. Maintain accurate records of all grievances, including details of the complaint, investigation, and resolution. Ensure compliance with all relevant policies and procedures regarding grievance management. Collaborate with internal stakeholders to resolve grievances effectively and efficiently. (50%)
• Identify service recovery opportunities and collaborate with clinical and operational teams to address patient and family concerns. Collaborate with clinical and operational teams to effectively de-escalate and provide crisis intervention assistance in difficult patient and family interactions. Respond promptly and empathetically to patient concerns and complaints, both verbal and written. Conduct thorough investigations into patient grievances, gathering all relevant information and perspectives. Develop and implement appropriate service recovery plans to address patient concerns and restore their trust. Track and monitor the effectiveness of service recovery efforts, identifying areas for improvement. Identify patient safety and patient rights issues and escalate appropriately. Collaborate with Patient Safety officers to follow Allegations of Abuse algorithm in a timely manner. Collaborate with Regulatory leaders to investigate allegations of violation of patient rights, discrimination, or EMTALA in a timely manner. Collaborate with Revenue Cycle for care reviews. Collaborate with legal counsel to mitigate risk. Collaborate with Quality to provide trends regarding care concerns. Collaborate with EEHI for discrimination concerns. Participate in root cause analyses. (20%)
• PFAC & Leadership (10%) : Facilitate weekly grievance committee meetings with entity senior leadership. Present data and provide analysis, identify opportunities for improvement at quarterly PIOC meetings. Participate in entity Patient Experience Senior leadership meetings in collaboration with network Patient Experience leadership. Co-chair the Patient Experience Team. Facilitate meetings of the PFAC, ensuring a welcoming and inclusive environment for all participants. Guide discussions, gather feedback, and ensure that patient and family perspectives are incorporated into decision-making processes. Develop and implement strategies to enhance PFAC engagement and effectiveness. Communicate PFAC recommendations and insights to relevant stakeholders within the organization.
• Education, Training & Program Development (10%) : Design and present teaching, coaching, and mentoring service recovery tools and tactics for caregivers and role models Patient Experience Division behavior and performance expectations. Train and coach clinical and non-clinical staff on timely management of patient complaints and grievances in the incident management system. Provide ongoing education and training to staff on service recovery and grievance management best practices. Develop and maintain resources and materials to support patient advocacy and grievance resolution. Stay abreast of relevant regulations and industry best practices related to service recovery and grievance management.
• Rounding & Communication (10%) : Actively rounds in all departments while demonstrating leadership with conflict management and effective communication skills.

Performs other duties as assigned or required.

Qualifications : Minimum

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

Pay Range Minimum : $25.10

Pay Range Maximum : $38.91

Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.