Residential Services Specialist
2 weeks ago
Position Summary
The Residential Services Specialist at Molina Healthcare plays a crucial role in enhancing the effectiveness of the My Choice Wisconsin Managed Care Organization (MCO) by optimizing the utilization of residential service providers. This includes securing placements and conducting pre-contractual site inspections to ensure the selection of the least restrictive, most suitable, and cost-efficient options for our members.
Key Responsibilities
- Collaborate with the MCO's Interdisciplinary Teams (IDTs) to identify suitable community residential alternatives for members.
- Coordinate with IDT, DHS, and other stakeholders to facilitate timely and appropriate placements for members transitioning from Institutions for Mental Disease (IMDs) and State Centers.
- Ensure that all necessary residential authorizations are established in collaboration with the IDT.
- Gain an understanding of the specific needs of members requiring resources, identifying available facilities that are cost-effective and aligned with the members' desired outcomes.
- Assist in evaluating member-specific enhanced service requests related to Residential Services, proposing more suitable and economical alternatives, and consulting with Provider Relations & Network Staff as needed.
- Reach out to relevant residential providers to assess availability and capability to meet member requirements.
- Lead efforts during facility closures, ensuring members are relocated appropriately within the designated timeframe and participating in weekly relocation discussions with DHS, Providers, and Member Advocates.
- Document all activities related to member placement efforts in the designated system.
- Engage with non-contracted residential providers to explore contracting opportunities after exhausting all in-network options for challenging member placements, collaborating with Provider Relations Staff for further action.
- Manage workload effectively to ensure member placements are completed within the organization's established timelines.
- Work collaboratively with IDT and IDT Leadership to address member needs, ensuring timely and suitable placements.
- Foster and maintain supportive relationships with providers and IDTs within assigned counties.
- Provide educational resources to providers as necessary.
- Respond to inquiries and questions in a prompt manner.
- Participate in Provider Management Division projects as required.
- Perform other duties as assigned.
Qualifications
Education:
- Bachelor's degree in social services, health services, human services, business administration, or a related field.
Experience:
- Minimum of two years in care management or related social service experience with the MCO's target population.
- At least two years of experience in Community-Based Residential Facilities (CBRFs) or Adult Family Homes (AFHs) working with adult populations, including frail elderly, mental health, intellectually/developmentally disabled, and/or physically disabled adults.
Licensure:
- A valid Wisconsin Driver's License is required.
Knowledge, Skills, and Abilities:
- Strong organizational skills to manage multiple priorities in a dynamic environment.
- Excellent written and verbal communication abilities.
- Meticulous attention to detail.
- Proficient in MS Office Suite, including Excel, Word, Outlook, and PowerPoint.
- Ability to analyze and interpret business processes for continuous improvement.
Preferred Qualifications:
- Experience with individuals facing severe and persistent mental illness, behavioral issues, and/or AODA challenges.
- Familiarity with DHS Chapters 83, 88, and 89.
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $35.17 / HOURLY
*Actual compensation may vary based on geographic location, work experience, education, and/or skill level.
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