Position: Lead Functional Screener
Reports to: Regional Functional Screen Manager
Position Type: Full-Time, Exempt
Office Location: Waukesha, WI
Region for Coverage: Waukesha, Washington, Sheboygan and Ozaukee County
The Lead Functional Screener (Lead Screener) manages and completes Long Term Care Functional Screen (LTCFS) functions for the Managed Care Organization (MCO). This position joins a team of Lead Screeners who share some position duties and responsibilities, while primarily being responsible for their own screening region. Current opening is for a Lead Screener in Interdisciplinary Team (IDT) screening regions. In these regions, MCO Care Management Unit staff (CM or RN) complete LTCFS for members. The LTCFS Lead ensures accurate functional eligibility determination and rate setting of long-term care members through continuous education and training, quality improvement and quality assurance monitoring of IDT screeners. Position is housed in Functional Screen Division, which is part of the Quality Management Department, and reports to the Functional Screen Regional Manager.
Essential Duties and Responsibilities
Provide oversight of LTCFS compliance, training and quality for IDT screeners.
Assign and monitor timely completion of LTCFS for screeners using various reports in the MCOs proprietary IT application.
Monitor LTCFS quality and accuracy (annual, rescreen, edit) completed by IDT screeners.
Track and ensure adherence to LTCFS timeframes, utilizing LTCFS reports in MCO electronic record system. Review and track Level of Care and condition changes for MCO members, including follow-up consultation with IDT screeners and MCO Enrollment/Eligibility/Fiscal staff.
Ensure screeners meet MCO training requirements for new and existing screeners, Wisconsin Department of Health Services (DHS) trainings, and complete the mandatory Adult Screener Continuing Skills Testing (CST).
Inform IDT screeners of changes to LTCFS format and instructions. Assist with annual MetaStar and WI Department of Health Service Audits.
Implement and monitor corrective action plans, as required, to address IDT screener LTCFS certification or qualification concerns.
Conduct rescreens for members, as needed for Level of Care determination or for training purposes, allowing new/existing screeners to shadow a Lead Screener. Will commonly travel throughout assigned service area and make home visits for this purpose.
Respond to expedited requests from MCO senior leadership, Functional Screen Division Leadership, Best Practice Team, MetaStar, DHS to review, audit, and report back on member screens.
Other duties as assigned.
Knowledge/Skills and Abilities
Demonstrated expertise in LTCFS concepts, instructions, and screening.
Knowledge of long-term care, managed care, financial & functional eligibility for public LTC programs.
Supervisory skills to maximize staff professional development, meet performance expectations, and balance team with independent responsibilities.
Excellent communication and professionalism.
Ability to explain and teach complex and detailed material.
Advanced knowledge of Excel and Word processing applications.
Ability to work effectively with others and independently.
Ability to organize complex materials with strong attention to detail.
Ability to utilize quality monitoring tools (e.g., audits/LTCFS reviews).
Ability to adapt and interpret established practices and procedures to meet problems and situations to which the application is not clearly defined.
Ability to read, write, comprehend, communicate and recall complex instructions, correspondence and memos.
Available for daytime travel within MCO service regions, including screening members in their homes.
Bachelors degree from an accredited college or university in health & human services, or related field required.
LTCFS Certification required, with 1-3 years LTCFS, and Long-term care program experience.
Experience with data management, project coordination, training, and supervision, required.
Valid drivers license, reliable transportation, and auto insurance are required at the time of filing application and must be maintained throughout employment.
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