Patient Advocate II

Emory•Atlanta, GA

14h

About The Position

The Patient Advocate II manages the investigation, handling, regulatory compliance, and resolution of patient complaints and grievances. The role collaborates with teams across Emory Healthcare and external resources to facilitate service requests for patients, families, leaders, physicians, and staff. It resolves quality-of-service and quality-of-care complaints in accordance with regulatory requirements and Emory Healthcare policies, including policies concerning patient rights and responsibilities, HIPAA, nondiscrimination, and workplace violence. The Patient Advocate II also advises on patient experience strategy by representing the patient perspective, identifying service barriers, and supporting regulatory compliance. The position reports to the Patient Experience Director. The role handles complex and escalated cases, coordinates with interdisciplinary teams and organizational leaders, and supports formal grievance processes and regulatory reviews. It conducts rounds, provides coaching and training, prepares reports, and contributes to improvement initiatives. Local travel may be required, and the role may flex time to support Patient Relations coverage for other operating units.

Requirements

Three to five years of customer service or case management experience.
Demonstrated conflict-management and problem-solving skills.
Ability to navigate complex patient-care situations and interpret Emory Healthcare policies affecting safety and customer service.
Strong interpersonal communication and relationship-building skills.
Proficiency with customer databases, Microsoft Office, and electronic medical record systems.
Ability to work independently.
Strong organization and ability to prioritize multiple tasks and a caseload.
Telecommunication skills and proficiency using a multi-line phone and cell phone.
Any combination of education and experience is considered; an associate degree or case management/customer service experience is listed as acceptable.
Local travel may be required.

Nice To Haves

Healthcare experience working with clinical teams and/or patients is preferred.
A bachelor's degree in healthcare is preferred.

Responsibilities

Investigate complaints and grievances, including clarifying issues, reviewing charts and policies, and conducting interviews.
Manage timely intake, prioritization, and delegation of complaints, grievances, and service facilitation requests.
Comply with regulatory requirements and Emory Healthcare policy, including required written responses and event-management-system documentation.
Coordinate resolution of complex cases with leadership and other stakeholders.
Lead the creation, review, and timely distribution of reports for the Grievance Review Committee, Joint Commission surveys, and state regulatory agency visits.
Create and analyze reports from the Risk Management documentation system to identify trends and improvement opportunities.
Collaborate with Patient Financial Services on billing complaints as needed.
Conduct rounds in clinical and common areas, provide real-time coaching, partner with clinical teams, and report facility or safety issues.
Prepare and present patient advocacy training, including new employee orientation.
Respond to insurance-company inquiries about quality-of-care and service concerns, ensuring appropriate resolution, follow-up, and documentation.
Maintain timely, accurate, and thorough documentation of investigations and resolutions in the event management system.
Demonstrate leadership in committees and improvement projects related to patient experience.
Manage complex interdisciplinary cases and cases escalated to senior leaders; assess consequences, recommend actions, and advise on timely resolution.
Coordinate written and verbal responses to grievances with risk management, quality, social services, chaplaincy, physicians, public safety, executive administration, and financial services.
Convene and facilitate multidisciplinary groups and arrange family meetings as needed to resolve complaints and grievances.
Work with risk managers to identify and investigate matters that may become claims or lawsuits.
Manage the formal grievance process according to CMS rules, Joint Commission requirements, and Emory Healthcare policy.
Advise patients, families, and staff on Patient Rights and Responsibilities, including HIPAA and nondiscrimination policies.
Advise on patient-facing communications to improve patient experience.
Design and determine appropriate service-recovery gestures, including monetary compensation and reimbursement decisions.
Assist with recovery and resolution of lost belongings.
Triage incoming concerns and requests received by email, phone, or in person, and assign cases to leaders for follow-up and resolution.
Work with the manager on a personal professional development plan and identify training resources.
Attend meetings, huddles, and educational in-services as appropriate.
Participate in improvement projects to enhance workflows, efficiency, accuracy, and quality of care experience.
Participate in professional activities and organizations to maintain knowledge of current trends, practices, and developments.
Cross-train with other divisions and flex time as needed to support Patient Relations coverage for other operating units.
Perform other duties as assigned.