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Positions in this function receive, document, process and resolve provider, physician, organization and/or member feedback, complaints, and grievances. Serve as primary resource to senior management, plan sponsors, enrollees, and regulatory agencies across Washington and Oregon in resolution of oral and written complaints, feedback and appeals. Responsible for researching and resolving written, phone and internet complaints and complex or multi-issue appeals submitted by consumers, health plans, media, teammates, government and other regulatory agencies as well as UHG.
This position will provide expert knowledge of appeals process, resolution and assess appeals status of complaints. Conduct root cause analysis by identifying potential compliance, process, or systemic breakdowns; communicate findings to management; ensure appropriate actions are being taken for process improvement. Collaborates with department leaders, risk management, quality and compliance to resolve patient issues and identify key patient safety improvement opportunities. Develop Patient Feedback reports and analyzes data to identify opportunities for improvement. Promotes patient experience as measured by the survey through collaborative projects, training and education.
If you are located in Oregon, you will enjoy the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities
- Be the organizational outlet for patients and families concerns, complaints, and feedback
- Maintain a database of concerns, complaints, and feedback
- Process, respond and advocate for patients and families
- Responsible for the processes of complaints and feedback evaluation and triage
- Partner and maintain operational relationships with robust internal communication and assignment of complaints and feedback to the appropriate department for resolution
- Serve as a content expert for Patient Experience and Safety
- Identify improvements using Patient Feedback reports, and analytics
- Comfort with escalation of critical safety, patient experience and risk events
- Identify global/systemic issues related to individual cases and facilitate appropriate resolutions (e.g., compliance issues, contractual issues, process issues)
- Collaborate with applicable stakeholders to address and resolve global/systemic issues (e.g., senior leaders)
- Facilitate resolution of identified global/systemic issues
- Perform ongoing monitoring of process improvements and operational changes to ensure expected outcomes
- Identify and mitigate legal, business, media and/or reputational risk
- Provide support to audit activities and market conduct exams
- Represent executive management in external communications
- Provide Patient Experience education and training
- Build, manage and maintain effective relationships with applicable external stakeholders (e.g., members, employers, providers, regulators, state agencies, elected officials, agents, brokers, attorneys, collections agencies, vendors, third party administrators)
- Build, manage and maintain effective relationships with applicable internal stakeholders (e.g., senior and business leadership, legal/regulatory staff, government affairs, media relations, security)
- Ensure that all applicable internal and external stakeholders are properly informed during the resolution process, using appropriate feedback loops
- Escalate and communicate risk issues to appropriate stakeholders (e.g., senior leaders, legal/regulatory staff, government affairs, media relations, claims organization, security)
Skills
- De-escalating patients
- Extreme attention to detail on follow-up
- Critical thinking/problem-solving skills
- Outstanding verbal and written communication skills
- Ability to multitask
- Analytical skills
- Computer and data management skills
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications
- 2+ years of patient facing healthcare experience
- 1+ years of service recovery experience
- Experience working with electronic medical record and complaint management system (eg, EPIC, RLDatix, SalesForce, IDX, Mosaic, other ticketing systems)
- Proficiency with Microsoft suite of tools
- Ability to work standard business hours in PST zone
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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