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Ombudsman (Medicaid / Florida Health Plan) - REMOTE

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Molina Healthcare

2mo ago

  • Job
    Full-time
    Mid Level
  • Customer Relations
    Healthcare

AI generated summary

  • You need 3+ years in managed care, knowledge of Medicaid policies, strong customer service and communication skills, problem-solving abilities, and proficiency in data management and MS Office.
  • You will investigate member grievances, advocate for rights, resolve issues, ensure compliance, educate members, document interactions, and collaborate to enhance member satisfaction and care quality.

Requirements

  • At least 3 years of experience in a managed care environment, preferably in a Medicaid environment, or equivalent combination of relevant education and experience.
  • Knowledge of state Medicaid policies and programs.
  • Customer service and interpersonal skills; ability to empathize, remain calm under pressure, and build rapport with a diverse range of individuals.
  • Problem-solving and conflict resolution skills to address and resolve complex member/patient complaints and conflicts.
  • Ability to maintain strict confidentiality and handle sensitive information with integrity.
  • Sound judgment and decision-making abilities to assess situations, evaluate evidence, and recommend appropriate actions.
  • Proficiency in record-keeping and data management to accurately maintain and analyze complaint records and statistics.
  • Knowledge of health care systems, patient/member rights, and relevant laws and regulations.
  • Ability to work independently and make impartial decisions while adhering to professional ethics and standards.
  • Proficient in use of computer systems, software, and databases for documentation and data analysis.
  • Ability to navigate a large and complex matrixed organization.
  • Organizational and time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
  • Effective verbal and written communication skills, including ability to communicate with internal and external stakeholders, members, families, and health care providers.
  • Microsoft Office suite and applicable software programs proficiency.
  • Specific health plans may require state residency.

Responsibilities

  • Provides support for member advocacy activities. Responsible for resolution of member issues including investigating and resolving member grievances, identifying systemic challenges affecting the member experience, and advocating for member rights.
  • Plays a pivotal role in ensuring the well-being and satisfaction of members by addressing their concerns with a commitment to impartiality and independence.
  • Listens to member concerns and ensures members understand their rights and responsibilities.
  • Investigates member issues and works to find appropriate and fair resolutions; this includes addressing systemic issues impacting member ability to access health care services, provision of timely support from care management staff or other personnel, billing and communication support, and any other support needs related to the member experience.
  • Ensures that member rights are upheld and respected throughout their health care journey. This includes protecting member confidentiality, promoting informed consent, and ensuring cultural sensitivity and diversity; collaborates with relevant stakeholders to improve the overall quality of services provided to members under covered programs.
  • Provides information about available resources to members and assists with navigating the health care system.
  • Represents members on internal issues - investigates complaints thoroughly and impartially, gathering relevant information, interviewing involved parties, and reviewing medical records, policies and procedures.
  • Documents all interactions, complaints, investigations, and resolutions in a timely and accurate manner.
  • Prepares reports and statistical analyses to identify trends and areas for improvement.
  • Collaborates with health care professionals, administrators, and staff to address member concerns, develop strategies for quality improvement, and promote a member-centered approach to care.
  • Conducts educational sessions for members, member families, and health care staff on member rights, and effective communication strategies; travels and participates in all Molina member advisory boards for covered programs statewide.
  • Remains knowledgeable about relevant laws, regulations, and policies about member rights and health care quality; applies this knowledge to ensure compliance and advocates for necessary change when required.
  • Collaborates with other applicable departments and committees within the organization to implement initiatives that enhance member satisfaction, improve processes, and promote a culture of member-centered care.
  • Presents and reports findings/recommendations to the appropriate channels and health plan leadership.

FAQs

What is the job title for this position?

The job title is Ombudsman (Medicaid / Florida Health Plan).

Is this position remote?

Yes, this position is remote.

What are the primary responsibilities of the Ombudsman?

The primary responsibilities include resolving member grievances, investigating member issues, ensuring member rights are upheld, and advocating for member needs related to healthcare services.

What qualifications are required for this position?

Required qualifications include at least 3 years of experience in a managed care environment, knowledge of state Medicaid policies, strong customer service and problem-solving skills, and proficiency in data management.

Are there preferred qualifications for this role?

Yes, preferred qualifications include experience in member advocacy or complaint resolution in a healthcare setting, knowledge of relevant regulations, and certifications in conflict resolution or patient/member advocacy.

What types of skills are important for this position?

Important skills include effective communication, organizational and time-management abilities, sound judgment, and the ability to maintain confidentiality and handle sensitive information.

Will the Ombudsman need to travel for this job?

Yes, the Ombudsman will participate in Molina member advisory boards statewide, which may require travel.

What is the pay range for this position?

The pay range is $49,930 - $97,363 annually.

Does Molina Healthcare offer benefits for this position?

Yes, Molina Healthcare offers a competitive benefits and compensation package.

Are there any specific residency requirements for this role?

Yes, specific health plans may require state residency.

How will member issues be documented in this role?

All interactions, complaints, investigations, and resolutions must be documented in a timely and accurate manner.

What kind of trends and areas for improvement will the Ombudsman analyze?

The Ombudsman will prepare reports and statistical analyses to identify trends and areas for improving member satisfaction and service quality.

What type of educational sessions will the Ombudsman conduct?

The Ombudsman will conduct sessions on member rights and effective communication strategies for members, their families, and healthcare staff.

Can current Molina employees apply for this position?

Yes, current Molina employees interested in this position should apply through the Internal Job Board.

What is the organizational structure within which the Ombudsman will operate?

The Ombudsman will collaborate with healthcare professionals, administrators, and relevant stakeholders within a large and complex matrixed organization.

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Molina Healthcare

Science & Healthcare
Industry
10,001+
Employees

Mission & Purpose

Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care. Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.