Quality Assurance Analyst
Quality Assurance Analyst
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
- Job Location: 1101 Van Ness Ave
San Francisco CA 94109 -
- Description: Job Description & 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. -
- Qualifications & Skills:
- Education:
- Bachelors 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. - COVID-19 Vaccine (Facility Guideline):
- Required Booster - Medical/Religious Exemptions only
Employment Type
Full Time
