Accede Solutions Inc (accedesol.com)
Non-Clinical - Administrative/Quality Assurance Analyst
Accede Solutions Inc (accedesol.com), San Francisco, California, United States, 94199
Non-Clinical - Administrative/Quality Assurance Analyst
1 day ago Be among the first 25 applicants Responsibilities: The Grievances & Appeals Specialist plays a critical role in supporting patients and families by investigating complaints, concerns, and feedback received by the organization. The responsibilities include: Investigating patient/family complaints related to care quality, physician/provider actions, Sutter Health policies, and potential liability. Handling highly complex and conflict-heavy cases, requiring innovation and collaboration across departments. Working closely with managers, physicians, and staff to resolve patient grievances. Coordinating with Legal and Risk Management on medical-legal matters. Providing crisis intervention and mediation for complex institutional concerns. Conducting case investigations, including interviews with patients/families, medical record reviews, and policy/procedure evaluations. Facilitating case conferences and working with leadership to implement corrective action plans for quality improvement. Ensuring compliance with CMS Conditions of Participation and Sutter Health grievance policies. Maintaining a patient and family-centered approach, prioritizing transparency and resolution at the most appropriate levels. Managing a high caseload and ensuring timely documentation to meet regulatory timelines. Education: Bachelor's degree in Business Administration, Nursing, Social Work, or another healthcare-related field, or equivalent education/experience. Experience: Minimum 2 years of recent relevant experience in grievances, appeals, or patient advocacy. Skills Required: Strong oral and written communication for composing patient responses and synthesizing investigation findings. Analytical skills for medical record reviews, quality-of-care investigations, and patient safety concerns. Case management expertise, handling high volumes while ensuring timely compliance. Conflict resolution and problem-solving in a high-stakes, fast-paced healthcare environment. Technical proficiency in word processing, email, database management, and patient care software. Cultural competence and ability to navigate sensitive diversity-related concerns. Autonomy and resourcefulness in handling complex grievance cases. About Accede: Accede Solutions is a Nationally Certified Search firm providing services in multiple sectors. We are a Women and Minority-owned Business with a strong emphasis on Diversity, Equity, and Inclusion (DEI). We have managed and Implemented Talent Acquisition and Talent Management processes and had successful engagement with clients in the areas of Financial Services, Technology, healthcare and professional services. Equal Opportunity Employer:
Females/Minorities/Veterans/Individuals with Disabilities
#J-18808-Ljbffr
1 day ago Be among the first 25 applicants Responsibilities: The Grievances & Appeals Specialist plays a critical role in supporting patients and families by investigating complaints, concerns, and feedback received by the organization. The responsibilities include: Investigating patient/family complaints related to care quality, physician/provider actions, Sutter Health policies, and potential liability. Handling highly complex and conflict-heavy cases, requiring innovation and collaboration across departments. Working closely with managers, physicians, and staff to resolve patient grievances. Coordinating with Legal and Risk Management on medical-legal matters. Providing crisis intervention and mediation for complex institutional concerns. Conducting case investigations, including interviews with patients/families, medical record reviews, and policy/procedure evaluations. Facilitating case conferences and working with leadership to implement corrective action plans for quality improvement. Ensuring compliance with CMS Conditions of Participation and Sutter Health grievance policies. Maintaining a patient and family-centered approach, prioritizing transparency and resolution at the most appropriate levels. Managing a high caseload and ensuring timely documentation to meet regulatory timelines. Education: Bachelor's degree in Business Administration, Nursing, Social Work, or another healthcare-related field, or equivalent education/experience. Experience: Minimum 2 years of recent relevant experience in grievances, appeals, or patient advocacy. Skills Required: Strong oral and written communication for composing patient responses and synthesizing investigation findings. Analytical skills for medical record reviews, quality-of-care investigations, and patient safety concerns. Case management expertise, handling high volumes while ensuring timely compliance. Conflict resolution and problem-solving in a high-stakes, fast-paced healthcare environment. Technical proficiency in word processing, email, database management, and patient care software. Cultural competence and ability to navigate sensitive diversity-related concerns. Autonomy and resourcefulness in handling complex grievance cases. About Accede: Accede Solutions is a Nationally Certified Search firm providing services in multiple sectors. We are a Women and Minority-owned Business with a strong emphasis on Diversity, Equity, and Inclusion (DEI). We have managed and Implemented Talent Acquisition and Talent Management processes and had successful engagement with clients in the areas of Financial Services, Technology, healthcare and professional services. Equal Opportunity Employer:
Females/Minorities/Veterans/Individuals with Disabilities
#J-18808-Ljbffr