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Job Description
Description: _Work from home flexible! Position will support Wood and Portage county (and/or based on business need). Traveling required._
Position Summary:
The Functional Eligibility Specialist, as part of the Enrollment and Eligibility Division, serves enrolled members who meet the following target populations: frail elders, adults with physical disabilities and adults with intellectual/developmental disabilities.
The position’s goal, under the general direction of the Functional Eligibility Supervisor, is to timely and accurately determine member eligibility for the Family Care Program per organizational policy and procedure while adhering to Department of Health Services (DHS) contract requirements. The Functional Eligibility Specialist is responsible for conducting accurate, consistent, and detailed functional assessments. These assessments serve as the foundation for the Comprehensive Strength Based Assessment completed by care management staff, provide a basis for care planning activities based upon Lakeland Care, Inc.’s (LCI) policies and procedures, and directly influence the organization’s capitation.
In this position, the Functional Eligibility Specialist meets face to face with members to complete the Long-Term Care Functional Screen (LTCFS) and supplementary evidenced based screening tools, as needed.
Essential Competencies:
Accountability
Position Summary:
The Functional Eligibility Specialist, as part of the Enrollment and Eligibility Division, serves enrolled members who meet the following target populations: frail elders, adults with physical disabilities and adults with intellectual/developmental disabilities.
The position’s goal, under the general direction of the Functional Eligibility Supervisor, is to timely and accurately determine member eligibility for the Family Care Program per organizational policy and procedure while adhering to Department of Health Services (DHS) contract requirements. The Functional Eligibility Specialist is responsible for conducting accurate, consistent, and detailed functional assessments. These assessments serve as the foundation for the Comprehensive Strength Based Assessment completed by care management staff, provide a basis for care planning activities based upon Lakeland Care, Inc.’s (LCI) policies and procedures, and directly influence the organization’s capitation.
In this position, the Functional Eligibility Specialist meets face to face with members to complete the Long-Term Care Functional Screen (LTCFS) and supplementary evidenced based screening tools, as needed.
Essential Competencies:
Accountability
Timely complete the LTCFS with members, Legal Representatives, Providers, and/or Natural Supports as per organizational policies.
Conduct an interview with all applicable parties to discern needed information to complete the screen and validate screen findings.
Determine the amount of assistance a member requires with completing tasks safely.
Critical Thinking
To support member care, conduct evidence-based screenings and share the results per policy.
Objectively determine the correlation between members’ current medical diagnosis and their functional abilities.
Commitment to Excellence
Achieve and maintain certification to administer the LTCFS to include passing the State’s Continuing Skills Test.
Maintain contemporary knowledge to ensure compliance with Federal and State regulations.
Interpersonal Awareness
Exhibit maturity, resiliency and sound judgement when dealing with organizational challenges.
Demonstrate emotions appropriate to the situation and continue to perform steadily and effectively.
Relationship Building
Coordinate and participate in meetings with the Interdisciplinary Team (IDT) staff to discuss the screen findings.
Organizational Regard
Participate in the organization’s Functional Screen Quality Management Program.
Maintain the confidentiality of client information and protected health information as required by State and Federal regulations, including the Health Insurance Portability and Accountability (HIPAA) Act of 1996.
The duties listed above are typical for this position. These are not to be construed as exclusive or all-inclusive. Other duties may be required and assigned.
Work Relationships and Scope:
General work direction is received from the Functional Eligibility Supervisor. Decisions are made within the policies and procedures established under Lakeland Care. There is internal and external interaction with other professionals and routine interaction with the IDT staff.
Requirements:
Have a bachelor’s degree or more advanced degree in a health or human services related field required or current license to practice as a Registered Nurse (RN) in Wisconsin pursuant to Wis. Stat. 441.06.
Minimum of one (1) year of experience working in a professional capacity with at least one of the target groups served by Family Care.
Possess current State of Wisconsin Long-Term Care Functional Screen certification and have recent experience administering the LTCFS; or will pass the online LTCFS Training Course within 30 days of hire.
Maintain LTCFS certification in ‘good standing’ by successfully completing all mandatory certification courses, exams, refresher courses, and continuing skills testing as required by DHS.
Excellent active listening and interviewing skills.
Strong interpersonal and communication skills, both verbal and written.
Ability to establish and maintain effective working relationships with stakeholders.
Ability to comprehend and apply critical and complex information.
Capability to be flexible and adaptable.
Working knowledge of basic computer programs and adequate typing skills.
Capacity 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 the state of Wisconsin. Current WI driver’s license, acceptable driving record and proof of adequate insurance required.
Working Conditions:
Work is largely performed remotely, or in an office environment, and at various locations in the community including member’s homes which may or may not have accommodations for individuals with disabilities.
Work hours are generally during normal business hours but may require flexible start and leave times.
_APPLICATION DEADLINE DATE: Accepting until filled._
_For questions on this role, please reach out to the Talent Acquisition Specialist Becky Vang at _
_COMPENSATION CAN BE DISCUSSED WITH HUMAN RESOURCES._
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_Lakeland Care offers the Family Care Program in the following 22 counties: Fond du Lac, Manitowoc, Winnebago, Calumet, Outagamie, Waupaca, Kewaunee, Oconto, Brown, Door, Shawano, Marinette, Menominee, Florence, Forest, Langlade, Lincoln, Marathon, Oneida, Portage, Vilas and Wood._
_Our Mission_
_Empowering individuals. Strengthening communities. Inspiring futures._
_Our Vision_
_To create a world we all want to live in._
_Our Core Values_
_Kindness – We believe kindness is always possible and that no compassionate act is ever wasted._
_Inclusion – We believe that open hearts and open minds are the only path to a brighter future._
_Trust – We believe that honesty is still in style and that promises still have power._
Job Type: Full-time
