Adult Family Home Certifier

About the role

Reporting to the Supervisor of Provider Engagement, you will oversee the certification of new and existing 1-2 bed adult family homes in iCare/Humana network. You will cultivate our social community through community advocacy programs and active engagement with community members. You will travel throughout Southwestern WI working with our providers.

Responsibilities

• Sustain positive working relationships with team members and provide excellent customer service to certified 1-2 bed Adult Family Home (AFH) providers to support the vision for residential transformation.
• Ensure compliance with the Medicaid Standards for Certified 1-2 Bed Adult Family Homes during the certification and recertification of assigned AFH's.
• Screen provider documentation to check eligibility to become certified.
• Independently complete Adult Family Home certification process for all new homes in assigned region of the network.
• Annually re-certify all certified AFH's in assigned service region, maintaining timely and thorough completion of all necessary documentation.
• Verify and document that you correct all cited areas of non-compliances or areas of the standards that you must bring into compliance before you issue a certification.
• Maintain experience of the Medicaid Standards for Certified 1-2 Bed Adult Family Homes and DHS contract language about certified AFH expectations for providers and MCO staff.
• Lead efforts around any provider plans of correction, terminations or revocation of certification.
• Ensure a network of certified adult family homes that increases community connections, supports member choice and dignity, and fosters full participation in communities.
• Participate in ongoing training; maintain up-to-date knowledge to ensure compliance with Medicaid Standards and organizational practices.
• Must travel within assigned region to complete certifications and recertification's. Ability to visit homes on an emergent basis.

Required Qualifications

• Bachelor's degree
• 1 year of experience understanding the requirements for Residential Providers.
• Must reside within the State of WI or commutable to Southwest, WI within approximately 30 mins
• Able to travel 50-60% of your time throughout Southwest, WI region

Preferred Qualifications

• 1 or more years of experience in Managed Care
• Knowledge of Medicaid standards for 1-2 bed Adult Family Homes and all related and reference standards.

Work location and schedule

This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes. Work location: Southwest Wisconsin. Travel: up to 50-60% throughout coverage area. Hours: Monday through Friday, 8:00 am – 4:30 pm CST.

Work at home requirements

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Pay

$58,700 - $70,400 per year. This job is eligible for a bonus incentive plan based upon company and/or individual performance.

Benefits

Humana offers competitive benefits that support whole-person well-being, including medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.