Job Description

Join our award winning culture as we serve members in your area!

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.

The Functional Eligibility Specialist is responsible for conducting accurate, consistent, and detailed functional assessments. These assessments serve as the foundation for the Comprehensive Strength Based Assessment completed by care management staff, provide a basis for care planning activities based upon Lakeland Care, Inc.’s (LCI) policies and procedures, and directly influence the organization’s capitation.

Key duties include conducting thorough functional assessments, supporting care planning, and meeting members in person to complete the Long-Term Care Functional Screen (LTCFS) and other evidence-based tools.

Essential Competencies:

• Timely completion of the LTCFS with members, Legal Representatives, Providers, and/or Natural Supports as per organizational policies.
• Motivational interviewing with all applicable parties to discern information to complete the screen and validate screen findings.
• Determine the amount of assistance a member requires to complete tasks safely.
• To support member care, conduct evidence-based screenings and effectively communicate the results per policy.
• Objectively determine the correlation between members’ current medical diagnosis and their functional abilities.
• Achieve and maintain certification to administer the LTCFS to include passing the State’s Continuing Skills Test.
• Maintain contemporary knowledge to ensure compliance with Federal and State regulations.
• Exhibit maturity, resiliency and sound judgement when dealing with challenging conversations.
• Demonstrate emotions appropriate to the situation and continue to perform steadily and effectively.
• Coordinate and participate in meetings with the Interdisciplinary Team (IDT) staff to discuss the screen findings.
• Participate in the organization’s Functional Screen Quality Management Program.
• 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

• Have a bachelor’s degree or more advanced degree in a health or human services related field required or current license to practice as a Registered Nurse (RN) in Wisconsin pursuant to Wis. Stat. § 441.06.
• Minimum of one (1) year of experience working in a professional capacity with at least one of the target groups served by Family Care.
• Possess current State of Wisconsin Long-Term Care Functional Screen certification and have recent experience administering the LTCFS; or will pass the online LTCFS Training Course within 30 days of hire.
• Maintain LTCFS certification in ‘good standing’ by successfully completing all mandatory certification courses, exams, refresher courses, and continuing skills 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.
• Ability to comprehend and apply critical and complex information.
• Capability to be flexible and adaptable.
• Working knowledge of basic computer programs and adequate typing skills.
• Capacity to organize and plan work effectively and independently.
• Ability to navigate challenging situations and take appropriate action.
• Understanding of basic Care Management principles.
• 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.

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Lakeland Care is a Wisconsin-based non-profit organization that focuses on creating a world we all want to live in. With long-standing roots as a managed care organization (MCO), we provide long-term care services to eligible elders and individuals with physical and intellectual or developmental disabilities. Currently we serve members in 22 counties and have 11 offices throughout the Central to North East region of Wisconsin.

Our Mission

Empowering individuals. Strengthening communities. Inspiring futures.

Our Vision

To create a world we all want to live in.

Our Core Values

Kindness – We believe kindness is always possible and that no compassionate act is ever wasted.

Inclusion – We believe that open hearts and open minds are the only path to a brighter future.

Trust – We believe that honesty is still in style and that promises still have power.

We are an equal employment opportunity employer functioning under an Affirmative Action Plan. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. We are an organization that participates in E-Verify.