Supervisor, Eligibility & Screening - Field travel in Milwaukee County, WI

Molina Healthcare•Long Beach, WI

About The Position

Leads and supervises team supporting long-term care eligibility, screening processes and coordination for older adults and adults with physical or intellectual disabilities. Contributes to overarching strategy to provide quality and cost-effective care. Essential Job Duties Hires, trains, develops and supervises eligibility screeners; responsible for hiring and training new eligibility screeners, check-ins with team members, feedback and coaching, and ongoing compliance and quality of eligibility screener work. Assists in problem-solving and decision-making related to screens, member related issues, adverse eligibility findings, timing of screens, coordination of screens with moves and discharges, and other screening issues that arise. Attends meetings and represents as subject matter expert and consultant to key stakeholders in regards to the long-term care functional screen (LTCFS) program, and attends and facilitate fair hearings related to functional ineligibility. Completes the adult LTCFS as required and outlined in applicable regulatory guidelines; this includes completing collateral contacts to verify screen findings with internal and external stakeholders, and verifying diagnosis information with physicians and/or the Social Security Administration (SSA). Complies with documentation and LTCFS program regulations, guidelines and meets screening quota. Participates in and assists with screener meetings, quizzes and testing. Collaborates on development, process improvement and ongoing quality management of services of related LTCFS materials/products. Provides data reports related to the LTCFS as requested. Maintains long-term functional screening LTCFS certification by completing and passing continuing skills testing (CST). Local travel may be required (based upon state/contractual requirements).

Requirements

At least 5 years of experience in health care, and at least 3 years experience managed long-term care and/or human services serving one of the target groups (adults with physical/intellectual disabilities or older adults), or equivalent combination of relevant education and experience., or equivalent combination of relevant education and experience.
Current long-term functional screening (LTCFS) certification.
Registered Nurse (RN) may be required for certain states (dependent upon state/contractual requirements). If licensed, license must be active and unrestricted.
Demonstrated understanding of electronic medical records and Health Insurance Portability and Accountability Act (HIPAA).
Strong organizational and time-management skills.
Ability to write routine reports, correspondence, and speak effectively with internal and external stakeholders.
Ability to regularly make decisions related to how a project or operation will be conducted.
Ability to read, analyze, and interpret business manuals, technical procedures, and government regulations.
Excellent verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

Nice To Haves

Supervisory/leadership experience.

Responsibilities

Hires, trains, develops and supervises eligibility screeners
Assists in problem-solving and decision-making related to screens
Attends meetings and represents as subject matter expert and consultant to key stakeholders in regards to the long-term care functional screen (LTCFS) program
Completes the adult LTCFS as required and outlined in applicable regulatory guidelines
Complies with documentation and LTCFS program regulations, guidelines and meets screening quota
Participates in and assists with screener meetings, quizzes and testing
Collaborates on development, process improvement and ongoing quality management of services of related LTCFS materials/products
Provides data reports related to the LTCFS as requested
Maintains long-term functional screening LTCFS certification by completing and passing continuing skills testing (CST)
Local travel may be required