Note: The job is a remote job and is open to candidates in USA. Humana is a health insurance company committed to putting health first for its customers. They are seeking a Long Term Care Functional Screener to conduct assessments for program eligibility and ensure compliance with state regulations while supporting the needs of members in the Family Care Partnership program.
Responsibilities
- Coordinate appointments with members or legal representative to complete Annual and Enrollment redetermination of functional eligibility within member’s home; conduct rescreens due to member change in functional abilities for redetermination of eligibility as identified by Interdisciplinary Team (IDT)
- Utilize established methodology of the Wisconsin LTCFS process to collect member-centered data regarding functional abilities, health status and needs-based use of personal and professional supports and verify consistency of member specific data between functional assessment and member’s record to ensure members functional needs are accurately reflected
- Collaborate with the IDT to ensure all assigned LTCFS rescreens are completed within the required time frame
- Submit information collected during face-to face interview and collaborative verification into WI State internet-based program while maintaining compliance of state mandated timelines & appropriate professional utilization of LTCFS Instruction Manual
- Effectively maintain updates of status to assigned members LTCFS rescreens on department spreadsheets to ensure adherence of State of WI and iCare LTCFS timeframes. Review Level of Care for iCare members including follow-up consultation with Grievance and Appeals or Enrollment/Eligibility/Fiscal staff
- Provide appropriate notice of Member Rights, in accordance with contractual requirements, to members who experience a change in level of care that may impact the benefit package or overall program eligibility
- Attend meetings and trainings as required to maintain & enhance knowledge of agency processes & the Long-Term Care Functional Screen
- Maintain LTCFS certification via completion of WI biennial Continuing Skills Test
Skills
- Four-year bachelor's degree in a Health or Human Services related field with one (1) year of experience working with at least one of the Family Care target populations OR be a Wisconsin licensed Registered Nurse with one (1) year of experience working with at least one of the Family Care target populations
- Selected individual must meet requirements and successfully complete online screener certification training course(s) and become certified as a functional screener
- Knowledge of Microsoft Office Word and Excel
- Exceptional verbal/written communication and interpersonal skills
- Ability to use a variety of electronic information applications/software programs
- This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits
- Current WI Adult LTCFS Certification or previous WI Adult LTCFS Certification
- Prior experience with Medicare & Medicaid recipients
- Previous experience with electronic case note documentation and experienced with documenting in multiple computer applications/systems
- Experience with health promotion, coaching and wellness
- Knowledge of community health and social service agencies and additional community resources
Benefits
- Medical
- Dental and vision benefits
- 401(k) retirement savings plan
- Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- Short-term and long-term disability
- Life insurance
Company Overview
Humana is a health insurance provider for individuals, families, and businesses. It was founded in 1964, and is headquartered in Louisville, Kentucky, USA, with a workforce of 10001+ employees. Its website is http://www.humana.com.
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