• Behavioral Health Ombudsman

    Job Locations US-RI-Smithfield
    Req No.
    2018-9965
    Department
    Behavioral Health
    Type
    Regular Full-Time
  • Overview

    To act as an impartial liaison between Neighborhood Health Plan (NHP) and our Behavioral Health vendor in order to address issues raised by behavioral health providers that serve Neighborhood Health of Rhode Island members. The ombudsman will seek to achieve a fair and expeditious resolution between the BH providers and our BH vendor. The ombudsman will ensure that all available resources for addressing provider issues have been utilized and will explore all options towards a viable resolution.  The ombudsman will have the authority to directly engage senior management and executive leadership when the standard channels are unable to resolve the issue.  In addition, the ombudsman will produce reports detailing the issues being referred, the outcomes / results of referred issues as well as recommendations for improvement moving forward.

    Responsibilities

    • Acts as a liaison and dedicated resource to the behavioral health and substance use providers as well as community advocacy groups.
    • Keeps senior and executive management informed of critical provider issues.
    • Possess a solid understanding of Medicare, Exchange and Medicaid Managed Care reimbursement methodologies for BH services
    • Possess a solid understanding of behavioral health and substance use disorder services such as in-patient, out-patient, and diversionary services; dual diagnoses programs; in-patient and out-patient detoxification facilities and addiction programs and provider types such as, but not limited to, individual psychiatrists, psychologists and clinical licensed social workers, hospitals and community behavioral health facilities, out-patient clinics and human service organizations
    • Identifies and responds to organizational and systemic provider issues and complaints
    • Works collaboratively with staff at all levels of the organization to resolve problems
    • Coordinates escalated issues with the appropriate partners at the delegated vendor
    • Attend Leadership Council, RIHCA and community meetings as needed to better understand provider issues and concerns
    • Identifies patterns of organizational and systematic issues and works with administration to develop solutions
    • Participates on committees, work groups, and/or process improvement teams that improve provider satisfaction
    • Supports the core functions of the behavioral health department and assists with the department’s objectives and projects as activities require
    • Other duties as assigned
    • An essential responsibility of all Neighborhood employees is to comply with all applicable law, rules, regulations, policies, and procedures. We expect all employees to act with the highest ethical standards and integrity.

    Qualifications

    Required:

    • Bachelors’ degree and at least 5 years’ experience in healthcare; with experience working with the behavioral health provider network in Rhode Island and surrounding areas
    • Demonstrated experience engaging and working with community leaders and stakeholders
    • Proven knowledge of local, state and federal behavioral health and substance use disorder  resources
    • Demonstrated ability to work as a change agent within and amongst different organizations.
    • Commitment to outstanding customer service and continuous quality and process improvement
    • Strong oral and written communication skills; strong interpersonal skills; ability to communicate and work effectively across all levels of the organization
    • The capacity to utilize effective advocacy to realize an organization’s mission; vision; and key values
    • Effective problem-solving skills; ability to manage multiple tasks; well-developed personal and organizational skills
    • Computer skills required (Word, Excel, Visio)
    • Knowledge of Medicaid and Medicare regulations
    • Ability to participate in and contribute to a high-functioning, dynamic work team

    Organizational Competencies:

    • Judgment and Decision Making
    • Gets Results
    • Collaboration and Teamwork
    • Business Awareness
    • Customer Focus

    Job Specific Competencies:

    • Resilience
    • Influencing & Negotiation
    • Relationship Building & Networking
    • Organizational Savvy
    • Problem Solving & Analysis

    FDR Oversight:

    • Business Lead Level:
      • In the role of business lead for assigned FDR; incumbent is responsible to complete comprehensive oversight and monitoring of their vendor that incorporates the following elements: efficient and effective operations; compliance with laws, regulations, policies, procedures; and other company performance issues designed to reduce risk and add value to the company

    Travel Expectations:

    • Local Travel Required

    Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

     

    Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org.

     

    Neighborhood is an EOE M/F/D/V and an E-Verify Employer

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