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Description

The Case Manager, Clinical Quality Investigations, is an expert consultant, investigator, case manager and delegate of Swedish Medical Center's Board for hospital and hospital-based outpatient clinical care grievances. This person operates in a high-volume, high-stress environment and has multi-campus responsibility to ensure that clinical care grievances are responded to and documented in compliance with Swedish Medical Center policy and in accordance with requirements of external regulatory agencies, including The Joint Commission, Det Norske Veritas, The Center for Medicare/Medicaid Services, and the Washington State Department of Health. The Case Manager is the primary intake for regulatory and business complaints and grievances concerning clinical quality of care, such as from the Medical and Nursing Quality Commissions, Better Business Bureau, Office of Civil Rights, and Medicare Quality Improvement Organization Program (contracted to Kepro as of 10/29/2019). When external regulatory agencies request a patient's medical record from Swedish Medical Center, it will be the responsibility of the Case Manager to perform a preliminary review of the record to identify any potential deficiencies in care, with the results reported to the Accreditation department. This role affects system change through analysis and reporting of common causes of clinical care grievances, advising clinical leaders of patterns and opportunities for improvement. Additionally, this person provides education to and directs all levels of the organization regarding appropriate and effective management of clinical care grievances. Acts as a resource to evaluate the standard of care and complex clinical concerns that have been initiated by the patient or their advocate. The Case Manager uses clinical expertise and effective analytic and communication skills to investigate, interpret and clearly communicate to the patient complex clinical and other findings. Interfaces with Risk Management to assess situations for hospital liability and develop appropriate responses, including recommending goodwill adjustments of patient bills. Interfaces with the Accreditation Department for concerns triggering non-compliance with regulatory standards, and with the Quality Department for needs related to root cause analysis and patient safety. This person works directly with a multicultural and socio-economically diverse patient population and with individuals who frequently demonstrate distress, threatening behavior and anger, collaborating with Security and law enforcement agencies as necessary to ensure safety of self, colleagues, patients, and visitors.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Swedish Shared Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Required Qualifications:

+ 5 years as a clinician in a healthcare setting with at least two of those years being in management, education, or related to clinical quality; or a graduate degree and at least 10 years of experience in a quality investigation position considered in lieu of no clinical education.

+ Working with individuals in distress and in developing quality improvement initiatives in healthcare.

+ Investigation, including review of medical documents and interpersonal interactions.

+ Managing upward and accomplishing desired results.

+ Experience in effective verbal communication both in large groups and one to one settings.

+ Documented experience in composing clear written communication with grammatical accuracy and appropriate, professional tone.

Preferred Qualifications:

+ Bachelor's Degree in Nursing or equivalent education/experience

+ Bachelors or Masters Degree in related field accompanied by relevant experience considered (see Experience and Skills qualifications).

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our mission of improving the health and wellbeing of each patient we serve.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.

Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

About the Team

Providence Swedish is the largest not-for-profit health care system in the greater Puget Sound area. It is comprised of eight hospital campuses (Ballard, Edmonds, Everett, Centralia, Cherry Hill (Seattle), First Hill (Seattle), Issaquah and Olympia); emergency rooms and specialty centers in Redmond (East King County) and the Mill Creek area in Everett; and Providence Swedish Medical Group, a network of 190+ primary care and specialty care locations throughout the Puget Sound. Whether through physician clinics, education, research and innovation or other outreach, we’re dedicated to improving the wellbeing of rural and urban communities by expanding access to quality health care for all.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

For any concerns with this posting relating to the posting requirements in RCW 49.58.110(1), please click here where you can access an email link to submit your concern.

**Requsition ID:** 407779

**Company:** Swedish Jobs

**Job Category:** Clinical Quality

**Job Function:** Quality/Process Improvements

**Job Schedule:** Full time

**Job Shift:** Day

**Career Track:** Business Professional

**Department:** 3900 SS CLINICA QUAL INV

**Address:** WA Seattle 747 Broadway

**Work Location:** Swedish First Hill 747 Broadway-Seattle

**Workplace Type:** On-site

**Pay Range:** $47.05 - $73.04

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.