Job Description

The Patient Services Specialist is responsible for serving as an expert in addressing patient grievances and providing guidance on Conditions for Coverage (CfC) related issues. The specialist assists the Patient Services Manager in planning and facilitating education, information dissemination, and training for the ESRD community, including beneficiaries, their family members, and professionals. Additionally, the specialist supports other functional areas of the organization as directed and performs other duties as assigned. This position reports to the Patient Services Manager.

Essential Duties and Responsibilities

1. Acts as contact to assess and investigate beneficiary grievances, works to resolve problems between patients and dialysis facilities promptly.
2. Under the direction of the Patient Services Manager, refers beneficiaries to the appropriate state agency and CMS if a patient files a grievance regarding a provider action that has placed any patient’s health in jeopardy. Refers as appropriate to other agencies regarding issues beyond the scope of the Network.
3. Provides technical assistance to beneficiaries, family members and providers in compliance with the CfC including Patients’ Rights, patient and provider responsibilities, and grievance procedures.
4. Manages incoming calls in a timely and respectful manner, including calls from potentially highly stressed beneficiaries, family members or providers with an inquiry or a grievance.
5. Act as a liaison with the ESRD beneficiaries, the provider community, and various partners to represent the Network.
6. Assists with coordination of educational activities on managing difficult patients, mediation, and conflict resolution for dialysis and transplant providers.
7. Facilitates and performs the necessary tasks to complete the grievance process.
8. Review and ensures all contacts are correctly entered into the database to meet CMS standard documentation requirements. Ensures all beneficiary, provider and other individual contacts are entered into the Patient Contact Utility (PCU) database within the timelines determined by CMS.
9. Manages the process of investigating involuntary discharge or transfer cases and makes referrals as appropriate.
10. Performs follow up on at-risk (for involuntary discharge or transfer) cases with the goal of averting the discharge when possible. Provides education, resources, and guidance to dialysis facility staff regarding discharge process and CMS regulations.
11. Acts as a resource to State Survey Agencies to answer questions related to grievance activities, if applicable, and sharing non-confidential information and as necessary, in the processing of State Survey Agency ESRD patient grievances and involuntary discharges.
12. Participates in coalition activities as directed by the Patient Services Manager.
13. Assists Network staff in the development, publication and distribution of beneficiary and provider educational resources as directed by Patient Services Manager (i.e. newsletters, patient materials, posters, booklets, fax blasts).
14. Completes focused grievance audits and other potential monthly deliverables for the assigned region on time per the Schedule of Deliverables
15. Participates on monthly CMS reporting calls as directed by Patient Services Manager and presents applicable information on CMS Community of Practice calls as requested.

Knowledge, Skills & Abilities

1. Demonstrates a high-level of interpersonal and communication skills, written and verbal
2. Experience in conflict resolution, crisis management; managing difficult, challenging, ethical and/or emotional consumer situations; and meditation skills utilizing a patient-centered approach are essential
3. Must be proficient in use of Microsoft Office products; spreadsheet, word processing e-mail, Internet browser and database software; and contact management systems.

Education, Experience, & Licensing Requirements

Education

1. Masters in social work (MSW) is required.

Experience

1. Social Work Licensure preferred (e.g., LSW or LCSW).
2. Knowledge of Nephrology, End Stage Renal Disease or dialysis preferred.
3. Case Management Experience preferred.

Travel Requirements

1. Employee will work remotely from a home-based office.

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