Supervisor, Eligibility & Screening (Milwaukee County, WI)

JOB DESCRIPTION Job SummaryLeads 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