Supervisor, Eligibility & Screening (Wisconsin)

The role is a hybrid role with travel to member location assigned and meeting at Molina office once a month. 

The candidate must be located at one of the below  Wisconsin (WI) locations:

Spooner (Washington County), Park falls (Price County), Menomonie (Dunn County), New Auburn / Eau Claire (Chippewa county), Arcadia (Trempealeau county), Tomah (Monroe county), Reedsburg (Sauk county), La Crosse (Lax County), Viroqua (Vernon county), Bloomington / Prairie du chein (Grant county), Madison/ Verona (Dane county).

JOB DESCRIPTION Job Summary

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). 
   

  Required Qualifications 

  
  
• 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. 
  Preferred Qualifications 
   
• Supervisory/leadership experience. 
  To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
  Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V