The HealthCare Ombudsman/Mediator functions as a trained alternative dispute professional offering patients, family members, staff & providers a conflict management program to resolve patient/ provider healthcare disputes early thereby improving patient safety & reducing the costs of health care dispute resolution. This position serves as a trusted & informal information resource, communication channel, complaint handler, facilitator, consultant, & practitioner for dispute resolution. This role acts to seek fair & equitable solutions to patient/provider problems & for suggesting dispute resolution processes for addressing & managing conflicts & for policy & procedural changes. Lastly, it brings issues to senior leadership to address care delivery improvement efforts & promotes effective relationships/communication between patients & providers.
Essential Functions:
- Implements the healthcare ombudsman/mediator (HCOM) program
- Establishes annual work plan & performance metrics to demonstrate program effectiveness, including patient & provider satisfaction, cost savings, cost avoidance in lawsuits averted, increased productivity, savings in management time, increased personnel resources & the promotion of patient safety initiatives
- Develops an on-going communications program, including informational materials for patients & family, staff training & awareness building & materials for external audiences
- Serves as a dispute resolution practitioner whose major function is to provide confidential & informal assistance to patients & providers in resolving patient care issues, including receiving inquiries for dispute resolution, listens impartially, & questions the patient/staff to help put the problem into perspective
- Conducts informal fact-finding & gathers information, including any general background information that may be helpful to understand the overall context of the dispute & assesses the overall gravity of the situation, & meets w/ the parties to discuss issues
- Analyzes & recommends options to assist the parties in the resolution of their dispute
- Serves as an impartial & independent third party for clients, focusing upon patient care issues
- Facilitates contact w/ other appropriate local/regional departments as necessary
- Develops collaborative relationships within the Medical Center & Regional departments to provide & facilitate a fair, open & creative atmosphere
- Provides feedback to senior management by tracking & analyzing types of patient & provider concerns, & in collaboration w/ appropriate stakeholder groups
- Identifies opportunities for improvement to policies & practices which contribute to systemic conflicts, concerns, & complaints
- Provides internal consulting services to providers on communication & dispute resolution strategies, designed to improve individual & organizational effectiveness
- 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 & informs upper management of patterns & trends affecting patient care
- Participates within the KP patient safety/risk management community
- Establishes external network of Ombudsman professionals to foster on-going program improvement & 'up-to-date' information
Qualifications:
Basic Qualifications:
- Extensive ( 10+ years) progressive experience in clinical or management roles in a health plan or multifaceted health care system desired
- Clinical or hospital/healthcare background (usually 10+ years) required
- Evidence of having taken & passed a 40 or more hour Ombudsman training course or equivalent experience (usually 100+ cases) or take & pass a 40 hours or more Ombudsman training course within the first 90 days of employment
- Evidence of having taken & passed 40 hours or more Mediation course or equivalent experience (usually 100+ cases) or take & pass a 40 or more hour Mediation training course within the first 90 days of employment
- Bachelor's degree required
- Master's degree in business, health care, public administration or related field desired
- Knowledge of relevant healthcare regulations (including HIPAA), accreditation standards, Ombudsman & Mediator Code of Ethics & state tort system (as it relates to medical malpractice)
- Knowledge of KP preferred
- Analytical/data management skills
- Program development expertise (strategic direction, work planning, communications, & implementation)
- Excellent written, presentation, & communication skills
- Analytical/data management skills
- Expertise in interpersonal skills, including active listening & relationship/trust/consensus building
- Ability to work w/ difficult situations w/ multiple interests/parties involved
- Flexibility to travel to various KP &/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, & presentations
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.