Supervisor, Eligibility & Screening (Wisconsin)

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

Job summary

Molina Healthcare in Wisconsin seeks a leads an eligibility screening team for long-term care. The role ensures quality, cost-effective care and coordinates screenings for older adults and adults with disabilities.

The position is hybrid with travel to member locations and monthly meetings at a Molina office. Candidates must reside in Wisconsin at counties including La Crosse, Eau Claire and Madison, among others.

Qualifications

• At least 5 years of health care experience and 3 years in long-term care or human services.
• Current LTCFS certification is required.
• RN license may be required in certain states and must be active if licensed.
• Understanding of EMR systems and HIPAA.
• Strong organizational and time-management skills.
• Ability to write routine reports and communicate with stakeholders.
• Proficiency with Microsoft Office.

Responsibilities

• Hire, train, and supervise eligibility screeners with coaching and quality checks.
• Solve issues related to screens, moves, discharges, and timing.
• Represent as SME for LTCFS and facilitate fair hearings on functional ineligibility.
• Complete LTCFS per regulations and verify diagnoses with physicians/SSA.
• Ensure documentation compliance and maintain screening quotas.
• Lead screener meetings, quizzes, and training sessions.
• Collaborate on LTCFS materials, processes, and quality improvement.
• Provide LTCFS data reports as requested.
• Maintain LTCFS certification via continuing skills testing (CST).
• Local travel may be required based on state/contractual requirements.

Skills

Organizational skills

Time management

Written communication

Verbal communication

HIPAA compliance

EMR knowledge

MS Office

Stakeholder collaboration

Analytical reading

Education

LTCFS certification

RN license (if required)

Tools

EMR systems

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.