Auditor, IRIS Functional Screening

Molina Healthcare • Long Beach, WI

2d

About The Position

Description JOB DESCRIPTION Job Summary Provides auditing support for long-term care screening processes for older adults and adults with physical or intellectual disabilities for The Management Group (TMG) IRIS Consultant Agency (ICA) participants. Contributes to overarching strategy to provide quality and cost-effective care. Essential Job Duties Reviews, processes, assigns and tracks changes in participant condition long-term functional screening (LTCFS) requests. Reviews and resolves cross validation issues that arise between the personal care screening tool (PCST) and the LTCFS per Department of Health (DHS) policy and IRIS protocols, and completes internal screen audits to identify issues, trends, training needs and provides report summaries of audit findings. Collaborates with the development, process improvement and ongoing quality management of the LTCFS processes, and completes the adult LTCFS assessments and documents appropriately as needed. As requested, provides back-up to LTCFS team, providing data reports and summaries, answering LTCFS general inbox email and calls, and assisting with entering and maintenance of financial and screen data information in The Management Group (TMG) data system. Assists as needed with new employee orientation and preparation and training of new screening specialists. Assists with the completion of internal quality and process reviews for screens completed by LTCFS team and assists with identifying trends and follow-up training identified in trends from the audits. Assists with completion of fair hearing statements related to functional eligibility fair hearing appeals as needed. 5% local travel may be required (based upon state/contractual requirements).

Requirements

• At least 2 years experience in health care, preferably in care coordination, with at least 1 year of experience working with target groups served by the IRIS program (adults with physical or intellectual disabilities or older adults), or equivalent combination of relevant education and experience.
• Must be currently certified to conduct/administer the adult long-term care functional screens or pass the Wisconsin adult long-term care functional screen certification (LTFS) modules (80% or higher on each module) within first week of hire and maintain certification as a screener.
• Bachelor of arts or science degree or more advanced degree in a health or human services related field (e.g. social work, psychology) or graduation from an accredited school of nursing. If a graduate from an accredited school of nursing, must have an active and unrestricted Wisconsin Registered Nurse (RN) license in good standing.
• Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
• Knowledge of long-term care programs, and familiarity with principles of self-determination.
• Demonstrated knowledge of community resources.
• Proactive and detail-oriented.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships and collaborate in a highly matrixed organization.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving, critical-thinking and strong math skills.
• Communication outreach and partnership development experience.
• Experience working with elderly and people with physical disabilities and developmental disabilities.
• Ability to take ownership of an assigned area and corresponding programs, and lead with success.
• Excellent verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.

Nice To Haves

• Current or former certification to conduct/administer adult long-term care functional screenings (LTCFS) in the state of Wisconsin.
• LTCFS auditing experience.

Responsibilities

• Reviews, processes, assigns and tracks changes in participant condition long-term functional screening (LTCFS) requests.
• Reviews and resolves cross validation issues that arise between the personal care screening tool (PCST) and the LTCFS per Department of Health (DHS) policy and IRIS protocols, and completes internal screen audits to identify issues, trends, training needs and provides report summaries of audit findings.
• Collaborates with the development, process improvement and ongoing quality management of the LTCFS processes, and completes the adult LTCFS assessments and documents appropriately as needed.
• As requested, provides back-up to LTCFS team, providing data reports and summaries, answering LTCFS general inbox email and calls, and assisting with entering and maintenance of financial and screen data information in The Management Group (TMG) data system.
• Assists as needed with new employee orientation and preparation and training of new screening specialists.
• Assists with the completion of internal quality and process reviews for screens completed by LTCFS team and assists with identifying trends and follow-up training identified in trends from the audits.
• Assists with completion of fair hearing statements related to functional eligibility fair hearing appeals as needed.
• 5% local travel may be required (based upon state/contractual requirements).

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level