North Carolina Medicaid Ombudsman

Pisgah Legal Services (PLS) is a community-based non-profit legal aid agency governed by a local Board of Directors. Located in the Blue Ridge Mountains of Western North Carolina (WNC), Pisgah Legal Services provides free civil legal assistance to low-income people in WNC. The organization currently has offices in Asheville, Brevard, Burnsville, Hendersonville, Highlands-Cashiers, Marshall, Newland, and Rutherfordton. With over 120 dedicated staff, including over 30 attorneys plus program staff, and an active group of 200 volunteer attorneys, the program provides free services to over 20,000 people per year to meet their basic needs, primarily in the poverty law areas of housing, public benefits, domestic violence prevention, health care, immigration, and consumer law.

The North Carolina Medicaid Ombudsman role will:

• Answer inbound calls and online intakes to assist individuals in search of answers/solutions to Medicaid-related health care questions.
• Provide referrals and engage in resolving disputes with Medicaid health insurance plans in English and/or Spanish when applicable.
• Assist with outreach in WNC to educate people about coverage changes and their rights under NC Medicaid;
• Provide referrals to appropriate agencies for applicants and enrollees with grievances, complaints, questions, or need for other Social Determinants of Health;
• Document detailed notes and enter data into a case management system to assist with identifying trends and systemic issues;
• Provide all information and services in a manner that is culturally and linguistically appropriate and ensure accessibility for individuals with disabilities; and

Qualifications

• Bilingual Spanish written and oral skills preferred but not required
• Knowledge of Medicaid, managed care systems, and/or healthcare environments
• Demonstrated skills at socio-economic and cultural sensitivity, commitment to equity
• Commitment to work collaboratively with all constituent groups, including staff, consumers, clients, board members, donors, community groups, member organizations and others
• Self-motivated, able to work independently
• Detail-oriented, accurate and organized
• Ability to understand, remember, and carry out complex instructions
• Excellent writing and verbal communication skills
• Strong interpersonal skills and the ability to work well with teams
• Bachelor’s Degree or equivalent experience in areas such as in social work, public health, public policy or a related field (degree not required)
• Proficiency in MS Office, including Word, Excel, Power Point and Adobe PDF professional; experience with Legal Server Case Manage software preferred.
• Ability to work independently and in a team environment; and
• Ability to effectively collaborate with co-workers and clients in virtual, face to face and meeting settings.

General Requirements

• Available 8am- 5pm daily, Monday-Friday except NC State holidays.
• Access to a reliable car with car insurance and have a valid driver’s license preferred (Mileage reimbursement provided);
• Able to work nights and/or weekends during high demand periods preferred;
• Possess socio-economic and cultural sensitivity and ability to communicate with persons in crisis or under stress; and
• Ability to multi-task and interact well with professionals, clients, and others.

Salary/ Benefits

Salary ranges from $40,533 - $58,666 depending on experience. Additional bilingual language skills that are applicable to this role may qualify for up to an additional $3k upon completing a language assessment test.

Our salary scale is predetermined based on the years of relative professional work experience that qualify for this position to ensure equity in pay. Pisgah Legal Services is a Living Wage Certified Employer.

Employees are eligible for medical, dental, vision and life insurance coverage the 1st of the month following the start date. Pisgah Legal Services (PLS) pays 100% of the Employee and 50% of the Dependent Cost for BCBS Medical and Dental coverage. PLS pays 50% of the Employee Coverage Cost for BCBS Vision coverage. PLS pays 100% of Long-Term & Short-Term Disability Coverage, Life Insurance Coverage of 5x base salary an additional $15,000 Life & AD&D Coverage. 401k Retirement Plan after 6 months of employment. Additional Fringe Benefits includes Pet Insurance, Paid Parental Leave, Paid Bereavement Leave, 13.5 Company Holidays, 22 Paid Leave Days, Paid Sabbatical Leave for eligible staff, Employee Assistance Program for entire household and a great working environment with work life balance! Click here to view our 2024 Benefits Guide.

To Apply

Submit your online application with resume and cover letter through our Career Center located at https://www.pisgahlegal.org/jobs.

PLS invites all applicants to include in their cover letter a statement about how your unique background and/or experiences might contribute to the diversity, cultural vitality, and perspective of our staff and legal services practice.

Pisgah Legal Services is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

As an Equal Opportunity Employer, we will provide reasonable accommodations to qualified persons with disabilities. Prospective and current employees are encouraged to discuss ADA accommodations with our Human Resources department.