Full Job Description
The HealthCare Ombudsman/Mediator functions as a trained alternative dispute resolution professional offering patients, family members, staff and providers a conflict management program to resolve patient/ provider healthcare disputes early and quickly thereby improving patient safety and reducing the costs of health care dispute resolution. Serves as a trusted and informal information resource, communication channel, complaint handler, facilitator, consultant, and practitioner for alternative dispute resolution. Acts to seek fair and equitable solutions to patient/provider problems and for suggesting dispute resolution processes for addressing and managing conflicts and for policy and procedural changes. Brings issues to senior leadership to address care delivery improvement efforts. Promotes effective relationships/communication between patients and providers.
- Implements the healthcare ombudsman/mediator (HCOM) program.
- Develops and implements an on-going communications program, including informational materials for patients and family, provider and staff training and awareness building and materials for external audiences.
Patient/Provider/Staff Ombudsman/ Mediator Process:
- Serves as an alternative dispute resolution practitioner whose major function is to provide confidential and informal assistance to patients and providers in resolving patient care issues.
- Receives inquiries for dispute resolution, listens impartially and questions the patient/staff/provider to help put the problem into perspective.
- Conducts informal fact-finding and gathers information, including any general background information that may be helpful to understand the overall context of the dispute and assesses the overall gravity of the situation, and meets with the parties to discuss issues.
- Based on an analysis of the situation, recommends options to assist the parties in the resolution of their dispute.
- Serves as an impartial and independent third party for clients, focusing on unanticipated medical outcomes.
- Facilitates contact with other appropriate local/ market area departments as necessary (e.g. Legal or Member Services).
Collaboration and Problem Solving:
- Develops collaborative relationships within the Medical Center and Market Area departments to provide and facilitate a fair, open, and creative atmosphere.
- Provides feedback to senior management by tracking and analyzing types of patient and provider concerns, and in collaboration with appropriate stakeholder groups.
- Identifies opportunities for improvement to policies and practices which contribute to systemic conflicts, concerns, and complaints.
- Provides internal consulting services to providers on communication and dispute resolution strategies, designed to improve individual and organizational safety effectiveness.
Analysis and Reporting:
- Maintains data set to support the evaluation of the effectiveness of the program.
- Analyzes aggregate data/information from HCOM case experience concerning patterns of complaints. Identifies and informs upper management of patterns and trends affecting patient care.
- Actively participates within the KP patient safety/risk management community, by sharing successful practices and disseminating learnings (in collaboration with Regional and National Risk Management functions).
- Establishes and maintains external network of Ombudsman and Mediator professionals to foster on-going program improvement and up-to-date information. Participates in all Advanced HCOM Trainings.
- Minimum of ten (10) years of progressive experience in clinical or management roles in a health plan or multi-faceted health care system desired.
- Bachelors degree required.
License, Certification, Registration
- Evidence of having taken and passed a 40 hour or more Mediation course or equivalent experience (usually 100+ cases) or take and pass a 40 or more hours Mediation training course within the first 90 days of employment.
- Knowledge of relevant healthcare regulations (including HIPAA), accreditory standards, Ombudsman & Mediator Code of Ethics, and state tort system (as it relates to medical malpractice).
- Demonstrated ability to work with difficult situations with multiple interests/parties involved.
- Demonstrated analytical/data management skills.
- Demonstrated program development expertise (strategic direction, work planning, communications, implementation).
- Demonstrated excellent written and presentation communication skills.
- Demonstrated expertise in interpersonal skills, including active listening and relationship/trust/consensus building.
- Flexibility to travel to various KP and/or contracted facilities within the coverage area, as applicable, to conduct HCOM responsibilities.
- Flexibility to travel to various locations across the program for training, advanced training, workshops, and presentations.
- Clinical or hospital/healthcare background (usually 10+ years) desired.
- Experience in a health plan or multifaceted health care system preferred.
- Masters degree in business, health care, public administration or related field strongly preferred.
- Knowledge of KP preferred.
- Knowledge of relevant healthcare regulations (including HIPAA), accreditory standards, Ombudsman & Mediator Code of Ethics and state tort system (as it relates to medical malpractice).
HoursPerWeek : 40
Workdays : Mon, Tue, Wed, Thu, Fri
Job Schedule :
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-HI-01|NUE|Non Union Employee
Job Level : Individual Contributor
Job Category : Compliance, Privacy & Regulatory
Travel : No