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

About the Role

Join our award-winning culture as we serve members in your area! Please note, applicants must live within a 50-mile radius of Shawano. The Functional Eligibility Specialist, as part of the Behavioral Health and Utilization Department, evaluates eligibility for frail elders, adults with physical disabilities, and adults with intellectual/developmental disabilities. Reporting to the Functional Eligibility Supervisor, this role ensures timely and accurate member eligibility determinations in accordance with organizational policies and procedures, while meeting Department of Health Services (DHS) contract requirements.

Responsibilities

• Conduct thorough functional assessments to serve as the foundation for the Comprehensive Strength Based Assessment completed by care management staff.
• Support care planning activities based upon Lakeland Care, Inc.’s (LCI) policies and procedures.
• Meet members in person to complete the Long-Term Care Functional Screen (LTCFS) and other evidence-based tools.
• Timely completion of the LTCFS with members, Legal Representatives, Providers, and/or Natural Supports as per organizational policies.
• Conduct motivational interviewing to discern information and validate screen findings.
• Determine the amount of assistance a member requires to complete tasks safely.
• Conduct evidence-based screenings and communicate results effectively per policy.
• Objectively determine the correlation between members’ current medical diagnosis and their functional abilities.
• Achieve and maintain certification to administer the LTCFS, including passing the State’s Continuing Skills Test.
• Maintain contemporary knowledge of Federal and State regulations to ensure compliance.
• Coordinate and participate in meetings with the Interdisciplinary Team (IDT) to discuss screen findings.
• Participate in the organization’s Functional Screen Quality Management Program.
• Maintain confidentiality of client information and protected health information as required by HIPAA and other regulations.

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.
• Maintain LTCFS certification in ‘good standing’ by completing all mandatory courses, exams, and 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.
• Capability to comprehend and apply critical and complex information.
• Flexibility and adaptability in work situations.
• Working knowledge of basic computer programs and adequate typing skills.
• Ability to organize and plan work effectively and independently.
• Understanding of basic Care Management principles.
• Ability to travel within the geographical service regions and throughout Wisconsin.
• Current driver’s license, acceptable driving record, and proof of adequate insurance.