Functional Eligibility Specialist (Shawano) (Home-Based with Field Travel)

Lakeland Care Incorporated•Shawano, WI

4d•Remote

About The Position

The Functional Eligibility Specialist works in the Behavioral Health and Utilization Department to evaluate eligibility for frail elders, adults with physical disabilities, and adults with intellectual/developmental disabilities. Reporting to the Functional Eligibility Supervisor, the specialist ensures timely and accurate member eligibility determinations in accordance with organizational policies and procedures and Department of Health Services (DHS) contract requirements. The role conducts accurate, consistent, and detailed functional assessments that inform care management staff’s Comprehensive Strength Based Assessments, support care planning under Lakeland Care, Inc. (LCI) policies and procedures, and influence the organization’s capitation. The specialist meets members in person to complete the Long-Term Care Functional Screen (LTCFS) and other evidence-based tools. Applicants must live within 50 miles of Shawano and be able to travel within the geographical service regions and throughout Wisconsin.

Requirements

Bachelor’s degree or higher in a health or human services-related field, or a current Wisconsin Registered Nurse (RN) license pursuant to Wis. Stat. § 441.06.
At least one year of professional experience working with at least one of the target groups served by Family Care.
Current Wisconsin Long-Term Care Functional Screen certification and recent experience administering the LTCFS, or ability to pass the online LTCFS Training Course within 30 days of hire.
Ability to maintain LTCFS certification in good standing by completing mandatory certification courses, exams, refresher courses, and continuing skills testing as required by DHS.
Excellent active listening and interviewing skills.
Strong verbal and written interpersonal and communication skills.
Ability to establish and maintain effective working relationships with stakeholders.
Ability to comprehend and apply critical and complex information.
Flexibility and adaptability.
Working knowledge of basic computer programs and adequate typing skills.
Ability to organize and plan work effectively and independently.
Ability to navigate challenging situations and take appropriate action.
Understanding of basic care management principles.
Ability to travel within the geographical service regions and throughout Wisconsin.
Current driver’s license, acceptable driving record, and proof of adequate insurance.
Must live within a 50-mile radius of Shawano.

Responsibilities

Complete the LTCFS with members, legal representatives, providers, and/or natural supports in a timely manner and in accordance with organizational policies.
Use motivational interviewing to obtain information and validate screen findings.
Determine the level of assistance members require to complete tasks safely.
Conduct evidence-based screenings to support member care and communicate results in accordance with policy.
Objectively assess the relationship between members’ medical diagnoses and functional abilities.
Obtain and maintain certification to administer the LTCFS, including passing the State’s Continuing Skills Test and completing required courses, exams, refreshers, and continuing skills testing.
Maintain current knowledge of applicable federal and state regulations.
Respond to challenging conversations with maturity, resiliency, sound judgment, and appropriate emotional expression.
Coordinate and participate in meetings with Interdisciplinary Team (IDT) staff to discuss screen findings.
Participate in the organization’s Functional Screen Quality Management Program.
Protect confidential client information and protected health information in accordance with state and federal regulations, including HIPAA.
Travel within the geographical service regions and throughout Wisconsin.