Supervisor, Eligibility & Screening (Milwaukee County, WI)

Molina Healthcare•Long Beach, WI

About The Position

Leads and supervises a team supporting long-term care eligibility, screening processes, and coordination for older adults and adults with physical or intellectual disabilities. Contributes to the overarching strategy to provide quality and cost-effective care.

Requirements

At least 5 years of experience in health care.
At least 3 years of experience in managed long-term care and/or human services serving adults with physical/intellectual disabilities or older adults, or an equivalent combination of relevant education and experience.
Current long-term functional screening (LTCFS) certification.
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 and 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.
Proficiency in Microsoft Office suite/applicable software programs.

Nice To Haves

Supervisory/leadership experience.
Registered Nurse (RN) may be required for certain states (dependent upon state/contractual requirements). If licensed, license must be active and unrestricted.

Responsibilities

Hires, trains, develops, and supervises eligibility screeners, including hiring and training new staff, conducting check-ins, providing feedback and coaching, and ensuring ongoing compliance and quality of work.
Assists in problem-solving and decision-making related to screens, member issues, adverse eligibility findings, timing of screens, coordination of screens with moves and discharges, and other screening issues.
Attends meetings and represents as a subject matter expert and consultant to key stakeholders regarding the long-term care functional screen (LTCFS) program.
Attends and facilitates fair hearings related to functional ineligibility.
Completes the adult LTCFS as required by regulatory guidelines, including collateral contacts to verify screen findings and diagnosis information.
Complies with documentation and LTCFS program regulations, guidelines, and meets screening quotas.
Participates in and assists with screener meetings, quizzes, and testing.
Collaborates on the development, process improvement, and ongoing quality management of services and 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.