Supervisor, Eligibility & Screening (Wisconsin)

Molina Healthcare; Kenosha (WI); Hybrid; USD 50,000 - 97,000; Full time

Job summary

Molina Healthcare is seeking a hybrid role in Wisconsin to lead a team supporting long-term care eligibility screening for older adults and individuals with disabilities. The role includes travel to member locations and monthly meetings at a Molina office.

You will hire and train screeners, coordinate screenings with care moves, and ensure regulatory compliance while contributing to quality and cost-effective care strategies.

Qualifications

• 5+ years of health care experience, 3+ years in long-term care support.
• Current LTCFS certification is required.
• RN license may be required in some states; active and unrestricted if licensed.
• Experience with electronic medical records and HIPAA compliance.
• Strong organizational and time-management skills.
• Ability to write routine reports and communicate with stakeholders.

Responsibilities

• Hire, train, and supervise eligibility screeners, provide coaching and ensure compliance.
• Resolve screening issues affecting timing and coordination with moves/discharges.
• Represent LTCFS as SME in meetings and facilitate fair hearings.
• Complete LTCFS tasks and verify findings with internal and external stakeholders.
• Ensure documentation follows LTCFS regulations and maintains quotas.
• Participate in screener meetings, quizzes, testing, and quality activities.
• Provide LTCFS data reports on request and contribute to materials.
• Maintain LTCFS certification via CST.
• Travel as required to meet state/contractual requirements.

Skills

Healthcare experience

LTCFS certification

HIPAA knowledge

Organizational skills

Communication skills

Microsoft Office proficiency

Decision making

Report writing

Education

LTCFS certification

Tools

EMR/EHR systems

MS Office

Job description

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.
• 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.
• Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Preferred Qualifications

• Supervisory/leadership experience.

Pay Range: $49,930 - $97,363 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.