Provider Certification Specialist (Org Wide)

Description

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

Under the supervision of the Provider Relations Residential Supervisor, the Certification Specialist provides initial certification, annual and any additional re-certification processes for certified Adult Family Homes (AFH) within Lakeland Care, Inc.’s (LCI) provider network. In addition, this position assists in the development of establishing strong partnerships with new and existing certified AFH service providers, community agencies and community representatives to ensure an adequate provider network for members. This position is responsible for ensuring the certified AFH provider documents are updated timely. The Certification Specialist will also assist the Provider Relations Division with on-site visits to the certified AFH providers, monitor and analyze associated quality-related data and ensure providers are consistently adhering to established contract requirements.     

This position has a multi-county focus and works closely with both Provider Relations Managers to ensure all LCI contracted certified AFH providers meet specific contractual certification requirements, AFH standards and home and community-based services (HCBS) setting requirements.   

Essential Competencies: 

• Collaborate in developing certification and contracting standards for providers and consistent processes to ensure ongoing compliance with DHS contracting standards. 
• Maintain a thorough understanding of regulations relating to certification of 1-2 bed Adult Family Homes and Contracting requirements. 
• Attend training per DHS requirements for Certifying Agency: Qualifications and Responsibility and per training plan.  
• Conduct certification and recertification activities objectively and consistently based on documented evidence and applicable DHS standards, LCI requirements, and established certification procedures.
• Maintain complete, accurate, and timely documentation supporting certification, recertification, deficiencies, corrective actions, conditions of approval, exceptions, and other actions affecting a home's certification status
• Use established procedures and professional judgement to determine the level of compliance with all administrative, operational, physical environment and life-safety requirements, including quality of care and quality of life provisions; identify and communicate issues/concerns.  
• Review data monthly to identify trends in Network adequacy and capacity and make recommendations for action plans to address any gaps.
• Creative problem solving and flexibility in Service Provision and Contracting.
• Identify, document, and appropriately escalate potential noncompliance, health and safety concerns, or circumstances requiring additional review, professional inspection, corrective action, or other certification action
• Conduct required onsite certification and recertification reviews, validate application information and supporting documentation, observe the home and environment, and engage appropriate individuals as necessary to determine compliance with certification requirements
• Ensure adherence by the certified Adult Family Home provider to LCI contract, and the Wisconsin Medicaid Standards for Certified 1-2 Bed Adult Family Homes, and home and community-based services (HCBS) setting requirements. 
• Collaborate with other certification agencies regarding any quality concerns that may jeopardize the health and safety of residents that occur in a 1-2 bed AFH.
• Ensure providers have adequate training and training resources.   
• If requested, document AFH exceptions to any requirement standard in writing, and report all exception requests and all granted exceptions to DHS on a quarterly basis every year per DHS requirements.    
• Communicate effectively with LCI contracted providers as well as other LCI departments to support and enhance organizational practices.
• Respect other opinions and concerns and value diversity in thought and action.
• In collaboration with the Contracting and Development Manager provide training opportunities and/or educational resources related to certification and re-certification requirements to 1-2 bed AFHs and LCI inter-divisional staff as needed.    
• Attend professional meetings such as community provider association meetings, and others as assigned. Train/update other members of the Provider Relations team as appropriate.
• Collaborate with providers in LCI’s Contracting and Certification processes.
• Work collaboratively with Provider Representatives to ensure proactive solicitation of new 1-2 bed AFH providers to meet the changing needs of current and/or projected members of Lakeland Care.
• Work towards Continuous Improvement by evaluating systems, giving honest feedback and being open to/supporting organizational change.
• Maintain professional objectivity and immediately disclose any actual or potential conflict of interest, outside relationship, financial interest, gift, or other circumstance that could affect, or appear to affect, impartial certification activities.

Requirements

•  Bachelor’s degree in a human service or business-related field, or equivalent combination of formal education and experience (includes knowledge, skills, and abilities).
• One (1) year of experience completing AFH certifications or working directly with contracted providers is preferred.   
• One (1) year of experience working with LCI’s target populations preferred.
• Knowledge of the service provider industry, subcontracting, licensing, and regulatory systems; and knowledge of provider network contracting in a managed care model preferred.
• Excellent verbal and strong written communication skills are required.  
• Outstanding organizational skills with the ability to juggle multiple responsibilities required.
• Experience, training, skills and/or aptitude in the following areas are desired: collaboration with potential/current AFH providers; reading and understanding contract language, standards, and requirements, analyzing, and interpreting data, providing education and training toward improving outcomes, and comfort in addressing groups.
• 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), Lakeland Care provides long-term care services and supports to eligible frail elders and individuals with physical and intellectual or developmental disabilities to achieve their daily and lifelong goals through Wisconsin’s Family Care program. Currently we serve in 22 counties and have 10 offices in 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.