Functional Eligibility Specialist

Lakeland Care Incorporated • Shawano, WI

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About The Position

Join our award winning culture as we serve members in your area!

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.

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.

Responsibilities

• Timely complete the LTCFS with members, Legal Representatives, Providers, and/or Natural Supports as per organizational policies.
• Conduct interviews with all applicable parties to discern needed information to complete screens and validate screen findings.
• Coordinate and participate in meetings with the Interdisciplinary Team (IDT) staff to discuss the screen findings.
• Use evidence-based screenings to determine the amount of assistance a member requires with completing tasks safely.
• Objectively determine the correlation between members’ current medical diagnosis and their functional abilities.
• Participate in the organization’s Functional Screen Quality Management Program.
• 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.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level