Ombudsman Liaison

Job Description

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Ombudsman Liaison

Location : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of our Topeka, Kansas Elevance Health PulsePoint locations.

The Ombudsman Liaison is responsible for coordinating services with local community organizations and working with local advocacy organizations to assure that the members receiving supports through the LTSS/HCBS Waiver programs have access to Covered Services and non-covered services. Responsible for interacting with Kansas Department of Health and Environment (KDHE) and Kansas Department for Aging and Disability Services (KDADS) “State” equivalent ombudsman staff and submitting reports to KDHE and KDADS.

How you will make an impact:

Primary duties may include, but are not limited to:

Seeks fair/equitable solutions to member/provider problems. Recommends dispute resolution processes to address and manage conflicts; recommends policy and procedural changes. Brings issues to health plan executive leadership to address care delivery improvement efforts and promote effective relationships/communication between members and providers. Initiates, directs, and facilitates activities within the FCAAP/DJJP Steering. Act as the single point of contact between the State and the Healthy Blue for escalated Member concerns and questions. Investigate and resolve access and cultural sensitivity issues identified by Healthy Blue staff, State staff, Providers, advocate organizations, or Members. Monitor Grievances with Grievance personnel to look at trends or major areas of concern. Work with care coordinators to help link Members to necessary services and supports. Coordinate with the schools, community agencies, and State agencies, with special emphasis on foster children and providing services to Members. Recommend policy procedural changes to the Healthy Blue’s management including those needed to ensure/improve Member access to care and quality of care (changes can be recommended for both internal administrative policies and Provider requirements). Identify a staff person to function as a primary contact for Member advocacy groups and work with these groups to identify and correct Member access barriers. Participate in local community organizations to acquire knowledge and insight regarding the special health care needs of Members. Analyze systems functions through meetings with staff. Organize and provide training and educational materials for Healthy Blues’ staff and Providers to enhance their understanding of the values and practices of all cultures with which the Healthy Blue interact. Provide input to Healthy Blue’s management on how Provider changes will affect Member access and quality/continuity of care and develop/coordinate plans to minimize any potential problems. Review all informational material to be distributed to Members. Assist Members and Member representatives in obtaining medical records.

Minimum Requirements:

Requires a BA/BS degree and a minimum of 7 years of related experience; or any combination of education and experience, which would provide an equivalent background. Proven track record of developing programs and services for either LTSS or Behavioral Health populations

Preferred Skills, Capabilities and Experiences :

2 years of experience in a health care related field with requisite experience working with either LTSS or Behavioral Health populations, preferably working with low‑income populations, and have demonstrated expertise in topics related to LTSS, resiliency and recovery, and cultural competency.

Job Level:

Non-Management Exempt

Workshift:

Job Family:

MKT > Community Rel/Outreach & Educ

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance.

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