Patient Safety & Resolution Specialist - Risk Management - Full Time 8 Hour Days (Exempt) (Non-Union)

Reporting to the Program Manager, Patient Safety & Resolution, the Patient Safety, Risk & Resolution Specialist supports Keck Medicine of USC's systemwide approach to patient harm response, grievance management, and risk mitigation within the Office of Integrated Risk Management. The Specialist is responsible for the day-to-day management and administration of patient grievances, adverse event investigations, and Communication & Resolution Program (CRP) activities, ensuring timely, accurate, and compassionate responses to patient and family concerns. The role conducts structured investigations, drafts high-quality grievance and CRP communications, and supports claims, insurer reporting, subpoenas, and litigation-related activities in coordination with the Program Manager and Senior Director of Claims and Finance.

Essential Duties:

• Patient Concerns, Grievances & CRP Support * Receive, triage, and document patient and family concerns and regulatory grievances. * Draft grievance responses and CRP letters aligned with Program Manager standards. * Support early communication with patients and families following harm events. * Acts as a Communication Lead for CRP cases * Assist with preparation for patient/family meetings. * Escalate complex or high-risk cases to the Program Manager.
• Investigations & Case Development * Conduct structured investigations into adverse events and grievances. * Develop case timeline and create clinical information. * Collaborate with key stakeholders including clinical teams and OGC.
• Claims Administration & Insurance Coordination * Prepare and submit First Reports of Claim to BETARMA. * Maintain organized claims files and documentation. * Track deadlines and support insurer investigations.
• Litigation Support, Subpoenas & Discovery * Process subpoenas and legal record requests. * Assemble medical records, statements, and timelines. * Coordinate with OGC and outside counsel as directed.
• Data Management, Reporting & Analysis * Enter and manage data in Risk Management Systems (RMS). * Support development of reports and dashboards. * Analyze trends to identify learning opportunities.
• Learning, Systems Improvement & Education * Contribute to development of toolkits, templates, and workflows. * Assist in creating training materials related to grievances and patient safety. * Support organizational learning initiatives.
• Perform other duties as assigned.

Required Qualifications:

• Req Bachelor's Degree Legal, Compliance, Healthcare Administration, Risk Management, or related field.

• Req 5 years Experience in healthcare risk management, patient relations, grievance management, quality/safety, or medical litigation/claims.

• Req Conduct structured, objective investigations using interviews, record review, and chronology building.
• Req Analyze complex clinical and legal information and synthesize it into clear, accurate summaries.
• Req Draft high-quality grievance responses, CRP letters, and insurer reports with empathy and precision.
• Req Communicate effectively with patients, families, clinicians, executives, insurers, and counsel.
• Req Manage claims intake, insurer reporting, and documentation with accuracy and timeliness.
• Req Support litigation processes, including subpoenas, discovery coordination, and record assembly.
• Req Interpret and apply regulatory requirements (CMS, state, internal policy) to grievance and claims workflows.
• Req Maintain confidentiality, privilege protection, and defensible documentation standards.
• Req Navigate sensitive, emotionally charged interactions with professionalism and emotional intelligence.
• Req Coordinate across multidisciplinary teams and manage multiple deadlines in a dynamic environment.

Preferred Qualifications:

• Pref Master's degree in a related field.
• Pref Experience in an Academic Medical Center.
• Pref Experience in academic medical centers, hospital risk management, or insurance defense law
• Pref Knowledge of ASHRM best practices, communication resolution programs, and just culture frameworks
• Pref Familiarity with National Practitioner Data Bank (NPDB) reporting, healthcare disclosure laws, and international insurance policies
• Pref Certification - Job Relevant LEAN or Six Sigma Certification, Paralegal or Healthcare Risk Management Certification.

Required Licenses/Certifications:

• Req Fire Life Safety Training (LA City) Fire and Safety Certification. If no card upon hire, one must be obtained within 30 days of hire, and maintained by renewal before expiration date. (Required within LA City only)