Community Care Worker III (CT) Serves as a specialist in the Program Support Unit (PSU) performing moderately complex tasks related to managed care Long Term Services and Supports (LTSS). Duties include case management activity, for example helping people select a managed care organization (MCO), approving and denying eligibility for a Medicaid 1115 Waiver program, playing a key role in transitioning individuals from nursing facilities to the community (Promoting Independence), entering or validating waiver eligibility records in authorization systems, notifying members of Medicaid 1115 Waiver program eligibility, managing fair hearing request for Medicaid 1115 Waiver program denials, transfer of Medicaid 1115 waiver program cases, and coordinating the aging out process for individuals enrolled in the Medically Dependent Children Program (MDCP). Work involves frequent contact with case managers in Community Care Eligibility Services (CCES), individuals enrolled in or applying for 1915(c) waiver services, service providers, LTSS MCOs, relocation specialists, nursing facility staff, the public, Health and Human Services Commission, Managed Care Compliance and Operations, Health Plan Management, and Medicaid for the Elderly and People with Disabilities (MEPD) staff. Works under general supervision with moderate latitude for the use of initiative and independent judgment. Work includes operating a computer and an extensive knowledge of CCES/PSU programs and software.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. (60%) Develops, coordinates, and explains Medicaid 1115 Waiver programs to applicants and members and authorizes services, such as approval and denial of waiver services, sending approval or denial notices to applicants, members and other key parties, validating eligibility in appropriate systems, registering the waiver program eligibility in authorization systems, authorizing the MCO to begin services, coordinating with MEPD staff, and authorizing enrollment in a Medicaid 1115 Waiver program. (10%) Assists with management of the interest list activities, which includes confirming contact information is accurate, mailing enrollment packets, determining which MCO individuals want to enroll with, making follow-up contacts as needed, and ensuring individuals’ wish to be assessed for a Medicaid 1115 Waiver program. (10%) Provides policy interpretation, and coordination for activities related to transitioning individuals from the nursing home to the community, handling the transition of children aging out of MDCP services, and people who transition in and out of a Medicaid 1115 Waiver program. (5%) Monitors and tracks services provided by contract agencies to measure the effect of services delivered and to detect any problems. As appropriate, if timeframes are not followed by key players, contact the appropriate person to assist with resolution of obstacles and document the reason for the delay. (5%) Handle continuum of care issues related to LTSS for Medicaid 1115 Waiver members who have been disenrolled or transferred in or out of managed care service areas and are experiencing a gap in services. This could include coordinating with CCES, as appropriate. (5%) Assist Medicaid 1115 Waiver members who have been denied services to file a fair hearing with the state. Track and monitor appeal processes through to the decision. (5%) Handle duties such as completing reports to monitor program operations, researching and resolving errors in enrollment, or making referrals to MEPD for members who lose Supplemental Security Income (SSI) eligibility.
Knowledge Skills Abilities:
Knowledge of Medicaid 1115 Waiver programs, policies, and procedures. General knowledge of community and government service delivery systems, case guidelines, regulations and policies, interviewing techniques, mental illness and the emotional components of physical illness, individuals’ needs associated with disabilities, and community welfare resources. Skill in communicating effectively orally and in writing with all types of people, in all types of situations. Ability to convey instructions and explanations to individuals and key parties, to negotiate available services, and to train others. Ability to operate computer equipment and be proficient in the use of Outlook, Excel, Word, as well as a general understanding of various state software programs, e.g., TIERS, SAS, and CSIL. Skill in managing stress and high profile situations while maintaining a professional demeanor. Skill in identifying systemic problems and ways to resolve same. Skill and ability to multi-task under pressure. Skill and ability to monitor performance and give appropriate feedback. Skill and ability to manage workload effectively to meet goals and objectives of Medicaid 1115 Waiver programs, prevent problems and meet timeframes. Ability to identify potential problems that would have a negative impact on service delivery and act proactively to prevent the problem. Ability to establish priorities according to relative importance and deadlines, set goals, and manage time efficiently.
Registration or Licensure Requirements:
Registrations, Licensure Requirements or Certifications: NONE
Initial Selection Criteria:
High School Diploma or GED required. Preferred knowledge of or experience with Medicaid 1115 Waiver programs, LTSS, experience with MEPD services. Effective written and oral communication skills. Ability and experience with various types of computer equipment and software including, Outlook, Word, Excel, TIERS and SAS. Education and training that relates to job duties.
Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include: 4COX1. For more information, see the Texas State Auditor's Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx. HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work. I-9 Form - Click here to download the I-9 Form. In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the online application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview
Note: Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include: 4COX1. For more information, see the Texas State Auditor's Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx.
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.
I-9 Form - Click here to download the I-9 form.
In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.