Covenant Management Systems

Provider and Patient Relations Manager

Page 2

Covenant Management Systems

Job Description

Job Title: Provider and Patient Relations Manager / FLSA Status: Exempt
Department/Area: QL Administration / Job Code: 6011
Supervision: Reports to: CAO and the ARC Medical Director
Supervises: None

PURPOSE: Directly supports the ARC Medical Director, the ARC Associate Medical Director for Quality of Care and all medical group Department Chiefs to carry out their administrative and management roles. Acts as the primary contact for provider concerns and questions and patient complaints with an emphasis on both mitigation and trending. . Works closely with the Medical Director in carrying out the responsibilities of that office. Carries out all duties while maintaining absolute confidentiality while promoting the mission and philosophy of the organization.

ESSENTIAL FUNCTIONS:

· Acts as a resource for all physicians and other providers with regard to medicolegal, regulatory and compliance issues (i.e., legal resource, questions about operational or custody issues, etc.)

· Supports and facilitates administrative and management activities of Medical Directors and Department Chiefs.

· Acts as primary contact and coordinator for TMB complaint and subpoenas responses. Coordinates support and guidance for providers as they traverse these events.

· Manages the physician peer review case process supervised and guided by the Medical Director (organize meeting agendas, conduct chart reviews, identify cases, etc.)

· Works with Medical Director and other physician leadership to address issues concerning physician relations and disciplinary issues applying the disciplinary program including maintaining the disciplinary monitoring program.

· Continually evaluates informed consents and related processes

· Member of Risk Management Committee regarding physician issues.

· Acts as first line liaison for physicians in coordinating activities in response to medicolegal claims. Works with and coordinates communications with TMLT and defense counsel regarding potential legal and liability issues and keeps Medical Director informed.

· Patient Complaints; Receives and reviews patient complaints directly or by referral from Center Managers and other. Evaluates and addresses issues with patients and staff involved. Maintains the patient complaint database for purposes of trending. Reports the results of trending to senior management on an as needed basis but no less than twice a year addressing patterns of service quality and quality of care.

· Patient Termination of Care: Receives and evaluates requests to terminate patients from ARC’s care. Follows designated procedures (enters flags in EPIC, maintains spreadsheet, communicates with patients) to terminate patients when justified and works with Medical director and/or Chiefs to mitigate situations requiring alternative solutions. Coordinates decision-making regarding patient terminations with physicians and clinical staff according to company and Texas Medical Board guidelines.

· Patient Risk Management: Communicates with patients deemed to be non-compliant or presenting potential risk to themselves, the provider or the organization in order to mitigate the situation. Responds to miscellaneous requests from physicians, Center Managers and others for patient counseling/intervention.

· Has the authority to negotiate the resolution of patient complaints, potential claims, grievances, etc. upon advice of Peer Review Committee and Medical Director.

· Works closely with the Medical Director and Department Chiefs with regard to cases of provider impairment and/or discipline. Is responsible for arranging, coordinating, tracking and reporting actions that have been mandated by the Peer Review Committee and the Medical Director.

· Works closely with Medical Director, Department Chiefs and HR during physician termination process to assure a smooth transition with regard to benefits, non-compete covenants, tail professional liability insurance coverage, clinical record completion, etc.

· Manages and monitors the variety of physician and provider duties such as completion risk management CME, compliance attestations, and other responsibilities considered mandatory by the ARC Board, Peer Review Committee, Medical Director and/or the Department Chiefs.

· Manages the TMLT invoice for accuracy

· Attends monthly CAC meeting

OTHER DUTIES AND RESPONSIBILITIES:

● Performs other duties as assigned.

MINIMUM QUALIFICATIONS:

Education: Bachelor’s degree in a related field. Bachelor’s degree in nursing or coursework in healthcare administration is preferred.

Experience: Minimum of five (5) years of experience working with physicians, including experience in an outpatient clinic healthcare setting. Demonstrated leadership experience in the field of health care risk.

Knowledge, Skills, and Abilities:

● Must possess a strong understanding of how statutory and regulatory law shapes clinical health care risk management.

● Demonstrated ability to handle multiple tasks and to effectively prioritize work assignments.

● Intermediate Excel skills required.

● Ability to provide exceptional leadership, gain trust and influence others.

● Demonstrated ability to work effectively with individuals at all levels of the organization in alignment with the principles and practices, vision and mission of the organization, both administrative and fiscal.

● Demonstrated ability to communicate effectively and to supervise, coach, mentor, train, and evaluate all initiatives with and through Medical Director and Department Chiefs.

/ L. Crouching /

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/ S. Balancing /

R

F. Pushing/Pulling / R / M. Foot Controls /

/ T. Vision /

G. Hearing /

/ N. Talking /

/ U. Other

WORKING CONDITIONS: Please indicate any variances from normal working conditions:

Weather Conditions: Office environment.

Hours of Work: Typical work hours are Monday – Friday, 8:00 a.m. to 5:00 p.m.

Required Overtime/Weekend Hours: Occasional as required.

Travel: Occasional as required.

Work Space: Office environment.

Noise: Office environment.

Hazards: Office environment.

Required Safety Gear: Office environment or other as required.

WORKING ENVIRONMENT:

OSHA category for blood born pathogens for this position is a Category II: Involves possible exposure to blood or body fluids.

HR Signature: Date:

Employee Signature: ______Date: ______

Rev. 01/11/2012

Covenant Management Systems

CODES: C = Continuously, F = Frequently, O = Occasionally, and R = Rarely

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O

R

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O

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HR Signature: ______Date: ______

HR Signature: Date: