Ombudsman Liason - Program Manager

Elevance Health•Durham, NC

19h•Hybrid

About The Position

We are partnering with North Carolina DHHS to operationalize a statewide Medicaid Plan designed to support Medicaid-enrolled infants, children, youth, young adults, and families served by the child welfare system so that they receive seamless, integrated, and coordinated health care. Within the Children and Families Specialty Plan (CFSP), and regardless of where a member lives, they will have access to the same basic benefits and services, including Physical health, Behavioral health, Pharmacy, Intellectual/Developmental Disabilities (I/DD) services, long term services and supports, Unmet health-related resource needs, and Integrated care management. We envision a North Carolina where all children and families thrive in safe, stable, and nurturing homes. This position is responsible for coordinating services with local community organizations and working with local advocacy organizations to assure that the Children and Families Specialty Plan (CFSP) members have access to Covered Services and non-covered services. This position plays a crucial role in supporting individuals and families by educating and navigating stakeholders on the CFSP Foster Care program and its benefits. You will utilize your professional expertise, experience within the NC System of Care and exceptional communication skills to address inquiries. The Ombudsman Liaison - Program Manager is responsible for the development and ongoing management of one or more multi-year external client facing programs within a business unit. Program managers typically support business strategies through an integrated portfolio of external client facing projects or initiatives. A program manager may have responsibility for a piece of a larger enterprise/regional external client facing program.

Requirements

Requires a BA/BS and minimum of 5 years external client facing experience in program/project management; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

Graduate degree preferred.
Project management certification preferred.

Responsibilities

Develops and executes statewide ombudsman strategy for the NC Children and Families Specialty Plan (Healthy Blue Care Together) through strategic planning, collaborations, and strategic alliances.
Improves understanding of local advocacy organizations, philosophies, stakeholders, legislators and providers that interact with or influence members and policy.
Serves as an informal information resource, communication channel, complaint handler, facilitator, consultant, and practitioner for dispute resolution.
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.
Manages and coordinates the development, approval, implementation and compliance of on-going external client facing programs; develops program budget; ensures program meets its stated objectives; provides subject matter expertise in response to day to day external client facing business issues.
Researches applicable subject matter practices and remains aware of industry trends.
Manages external client facing relationships and partners with corporate and regional business areas.
Coordinates training related to external client facing program; develops program success measures and performs periodic assessments of program success.