Job Description

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

Under the direction of the Behavioral Health and Utilization Manager, the Residential Services Specialist will actively support Care Management’s understanding and utilization of the least restrictive and most integrated residential settings available to members when it is determined that a member requires residential care to best support outcomes. This role will support utilization of the best placement based on assessed needs when a member must utilize residential services. In addition, this role provides subject matter expertise when members with complex care planning needs require individualized and high-cost placements. The ability to build and maintain relationships with providers and IDT staff is essential to the success of this role.

The Residential Services Specialist reviews organizational data, analyzes utilization trends, and compares information to current policies, established guidelines, and LCI Membership. In addition to acting as a partner to Care Management, this position will routinely interface with other internal Divisions and external Provider Partners to support collaborative provider growth and development to ensure fiscal sustainability and appropriateness utilization of residential services.

Essential Competencies:

• Serve as a resource and collaborate through consultation with LCI’s Care Management staff to support comprehensive, outcome-based care planning for members with complex care planning needs, such as mental health support needs, behavioral health support needs, other challenging social or health determinants, etc.
• Review the member record and evaluate the impact of this information on the assessment and care planning process specific to the member’s potential need for residential services.
• Serve as a resource and collaborate through consultation with LCI’s Care Management staff to support 30 day notices from residential care providers.
• Collect, analyze, and utilize data to support informed decision making for member care and provider needs to promote holistic care planning.
• Develop and analyze proactive indicators to address changing and emerging needs of members.
• Identify barriers to placement and address problems cooperatively as they occur.
• Partner and collaborate with IDT Staff to understand and meet members’ community-based residential needs.
• Develop and provide training on new and/or more effective guidance to improve overall experiences with residential placement processes for LCI members, providers, and IDT staff.
• Uphold the guiding principles of the organization, lead by example, and hold each other and all staff accountable.
• Work with internal and external partners to identify opportunities to continue to improve process, streamline communication, and ensure a continually evolving support that meets the needs of Care Management.
• Exhibit maturity, resiliency and sound judgement when dealing with organizational challenges.
• Respond constructively to emotional situations, high pressure, and conflict.
• Collaborate with internal stakeholders, including CM Practice, Utilization, Behavioral Health, Provider Relations, and Business/Fiscal, to ensure quality and sustainability outcomes are met, as in alignment with our Strategic Plan and Goals.
• Work in partnership with other internal divisions to monitor, evaluate and process residential service rate negotiations for member changes in condition and exceptional care needs.
• Liaison with community and provider stakeholders as needed to develop and strengthen our service delivery outcomes and sustainability, simultaneously.
• Promote a strong commitment to cross departmental teamwork.
• Works in partnership with others to develop and maintain cost-effective residential placement practices, implement quality improvement initiatives, conduct utilization review, and review the effectiveness of service coordination policies and procedures to ensure effective delivery of the Family Care benefit in alignment with members’ needs.
• Assist with reviewing solutions for gaps and/or quality concerns within the Provider Development Specialists as it relates to residential placement. Assist in reviewing for the proper utilization of crisis stabilization/diversion facilities.

Requirements

• Bachelor’s degree in a Health or Human Services related field, or equivalent combination of education and experience (includes knowledge, skills, and abilities).
• Minimum of two (2) year’s professional experience in a long-term care organization or community-based setting required; work experience with one or more of the target groups served by Family Care preferred.
• Demonstrates proficiency in applying the Family Care principles and Resource Allocation Decision process to practice.
• Strong data analysis and application skills.
• Strong evaluation, assessment, and interview skills.
• Must demonstrate proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook).
• Must have exceptional verbal and written communication skills.
• Must have creative problem solving and critical thinking skills.
• Must have excellent organization and interpersonal skills.
• Must have strong analytical and negotiation skills.
• Ability to develop effective working relationships with providers, external stakeholders, and care management staff.
• 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.