Functional Eligibility Specialist (Manitowoc) (Home-Based with Field Travel)

About the role

The Functional Eligibility Specialist evaluates eligibility for frail elders, adults with physical disabilities, and adults with intellectual/developmental disabilities, ensuring timely and accurate member eligibility determinations in accordance with organizational policies and procedures, while meeting Department of Health Services (DHS) contract requirements.

Responsibilities

• Conduct accurate, consistent, and detailed functional assessments, including the Long-Term Care Functional Screen (LTCFS) and other evidence-based tools.
• Support care planning activities based upon Lakeland Care, Inc.’s (LCI) policies and procedures.
• Meet members in person to complete assessments and communicate results effectively.
• Determine the amount of assistance a member requires to complete tasks safely.
• Objectively determine the correlation between members’ current medical diagnosis and their functional abilities.
• Coordinate and participate in meetings with the Interdisciplinary Team (IDT) staff to discuss screen findings.
• 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.

Requirements

• Bachelor’s degree or more advanced degree in a health or human services related field, or current license to practice as a Registered Nurse (RN) in Wisconsin.
• Minimum of one (1) year of experience working in a professional capacity with at least one of the target groups served by Family Care.
• Current State of Wisconsin Long-Term Care Functional Screen certification, or ability to pass the online LTCFS Training Course within 30 days of hire.
• Excellent active listening and interviewing skills, strong interpersonal and communication skills, and ability to establish and maintain effective working relationships with stakeholders.
• Ability to comprehend and apply critical and complex information, and capacity to be flexible and adaptable.
• Working knowledge of basic computer programs, adequate typing skills, and ability to navigate challenging situations and take appropriate action.
• Understanding of basic Care Management principles and ability to travel within the geographical service regions and throughout the state of Wisconsin.
• Current driver’s license, acceptable driving record, and proof of adequate insurance required.

Qualifications

The ideal candidate will have a strong background in health or human services, excellent communication skills, and the ability to work effectively with diverse stakeholders. They will also be able to maintain certification to administer the LTCFS, stay up-to-date with Federal and State regulations, and exhibit maturity, resiliency, and sound judgment in challenging situations.

Skills

• Strong interpersonal and communication skills, both verbal and written.
• Ability to establish and maintain effective working relationships with stakeholders.
• Excellent active listening and interviewing skills.
• Ability to comprehend and apply critical and complex information.
• Capacity to be flexible and adaptable.