Specialist, Residential
3 weeks ago
Job Description
Job Summary
The Specialist, Residential - MCW is involved in a variety of activities to optimize the My Choice Wisconsin Managed Care Organization’s (MCO’s) use of residential providers, including identifying and securing placements and pre contracting site inspection visits, with the goal of utilizing least restrictive, most appropriate, and cost-effective options.
Job Duties
- Works closely with the MCO’s Interdisciplinary Teams (IDTs) to identify appropriate community residential options for members.
- Works with IDT, DHS, and other parties to ensure timely and appropriate placement for members discharging from Institutions for Mental Disease (IMDs) and State Centers.
- Works with IDT to ensure proper residential authorizations are in place.
- Become familiar with specific needs of member needing resources, identify available facilities that are most cost-effective, most integrated and meet the outcomes of the member.
- Assists in reviewing member-specific enhanced service requests related to Residential Services. Suggests more appropriate, cost-effective options and when appropriate consults with the appropriate Provider Relations & Network Staff for further review and triage.
- Completes reach outs to appropriate residential providers to determine availability and ability to meet member needs.
- Takes the lead on facility closures. Assists in Chapter 50 closures including ensuring members are properly relocated within allowed timeframe, tracking member relocations, and participating in weekly relocation calls with DHS, Provider, and Member Advocates.
- Documents activities related to member placement efforts in the system.
- Contacts non-contracted, residential providers for interest in contracting upon exhausting all In-Network providers in a challenging member placement. Liaises with Provider Relations Staff upon gaining interest and information from potential providers for Provider Contracting Staff to pursue a contract.
- Monitors and manages workload to ensure member placements are finalized within organization set timelines.
- Collaborates and problem solves with IDT and IDT Leadership regarding member needs to ensure timely and appropriate placement.
- Builds and maintains collaborative and supportive working relationships with providers and IDTs in assigned counties.
- Provides education to providers.
- Responds to overall questions/queries in a timely manner.
- Completes Provider Management Division projects, as needed.
- Other duties as assigned
Job Qualifications
Required Education:
- Bachelor’s degree in social services, health services, human services, business administration, or a related field.
Required Experience:
- Two or more years of experience in care management or related social service experience with persons in the MCO’s target population
- Two or more years of experience working in Community-Based Residential Facilities (CBRFs) or Adult Family Homes (AFH’s) with adult populations of frail elderly, mental health, intellectually/developmentally disabled, and/or physically disabled adults
Required Licensure or Certification:
- A valid Wisconsin Driver’s License.
Required Knowledge, Skills, and Abilities:
- Requires strong organizational skills to handle multiple priorities in a fast-paced environment.
- Strong written and verbal communication skills.
- Strong attention to detail.
- Proficient knowledge and skill using MS Office Products such as Excel, Word, Outlook & PowerPoint.
- Ability to read, evaluate and interpret business processes and procedures for continuous improvement.
Preferred Qualifications:
- Experience working with persons who have severe and persistent mental illness, behaviors, and/or AODA issues.
- Familiarity with DHS Chapters 83, 88, 89.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJCorp
Pay Range: $16.23 - $35.17 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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