HCS CASE MANAGERHome and Community-based Services (HCS) Waiver ProgramOVERVIEW
The HCS Case Manager is responsible for coordinating, monitoring, and supporting services provided to individuals enrolled in the Home and Community-based Services (HCS) Waiver Program. This position serves as a primary point of communication between individuals served, legally authorized representatives (LARs)/guardians, service coordinators, residential providers, direct care staff, nursing, behavioral support professionals, and other members of the interdisciplinary team.
The HCS Case Manager helps ensure that services are delivered in accordance with the individual's Individual Plan of Care (IPC), Person-Directed Plan (PDP), implementation plans, applicable Texas Health and Human Services Commission (HHSC) requirements, and agency policies and procedures.
This position requires strong organization, documentation, communication, and follow-through skills. The Case Manager is expected to maintain accurate records, monitor service delivery, identify compliance concerns, and coordinate timely resolution of issues affecting the health, safety, services, or quality of life of individuals served.
RESPONSIBILITIESCase Management & Service Coordination
- Maintain an assigned caseload of individuals receiving HCS services.
- Review each individual's current IPC, PDP, implementation plans, assessments, service authorizations, and supporting documentation.
- Ensure authorized services are being provided according to the individual's approved plan and identified needs.
- Maintain regular communication with individuals, guardians/LARs, service coordinators, residential providers, and other members of the interdisciplinary team.
- Coordinate and participate in IDT/Interdisciplinary Team meetings, annual planning meetings, service reviews, and other case-related meetings.
- Follow up on recommendations, identified concerns, and assigned action items until completion.
- Assist with coordination of changes in services, residential arrangements, providers, or individual needs.
IPC & Service Authorization Monitoring
- Monitor the individual's Individual Plan of Care (IPC) and authorized service amounts throughout the plan year.
- Track utilization of authorized services to help prevent unnecessary over-utilization or under-utilization.
- Identify discrepancies between authorized services, scheduled services, documentation, and services actually delivered.
- Communicate potential service authorization or utilization concerns to appropriate administrative and program personnel.
- Assist with annual IPC renewals, revisions, transfers, and other required service-planning activities.
- Ensure service changes are implemented only after appropriate authorization and documentation have been received.
Documentation & Record Management
- Maintain organized and complete individual records in accordance with agency and HHSC requirements.
- Review service documentation for completeness, accuracy, timeliness, and consistency with authorized services.
- Monitor required documentation including, as applicable:
- Service Delivery Logs
- Progress notes
- Residential documentation
- Nursing documentation
- Medication Administration Records (MARs)
- Behavioral support documentation
- Incident reports
- Assessments
- Implementation plans
- Emergency and safety documentation
- Follow up with staff and contractors regarding missing, incomplete, late, or inconsistent documentation.
- Maintain confidentiality of all individual information and comply with HIPAA and agency confidentiality requirements.
Individual & Guardian Support
- Maintain professional communication with individuals and their families, guardians, or LARs.
- Address concerns regarding service delivery and ensure appropriate agency personnel are notified when intervention is required.
- Promote individual choice, dignity, independence, community participation, and person-centered services.
- Advocate for individuals to receive services and supports consistent with their identified needs and approved plans.
- Document significant communications, concerns, resolutions, and follow-up activities.
Residential & Provider Oversight
- Maintain communication with Host Home/Companion Care providers, Residential Support Services (RSS) staff, Supported Living providers, CFC/PAS-Hab attendants, and other contracted service providers, as applicable.
- Monitor whether residential and community-based services are being delivered according to the individual's plan.
- Identify concerns involving staffing, service delivery, documentation, environmental conditions, health and safety, or provider compliance.
- Coordinate with administrative and quality assurance personnel when corrective action or additional monitoring is required.
- Assist with transitions involving residential placements, provider changes, hospitalizations, discharges, or changes in an individual's level of support.
Health, Safety & Incident Management
- Immediately communicate significant health, safety, behavioral, abuse, neglect, exploitation, or other reportable concerns according to agency policy and applicable reporting requirements.
- Assist with obtaining and organizing documentation related to incidents and follow-up activities.
- Monitor completion of recommendations resulting from incidents, investigations, medical appointments, hospitalizations, or IDT meetings.
- Work collaboratively with nursing, behavioral support, residential, and administrative personnel when an individual experiences a significant change in condition or circumstances.
- Participate in risk management and corrective action activities when assigned.
Compliance & Quality Assurance
- Assist the agency in maintaining compliance with applicable HCS Waiver requirements, HHSC standards, agency policies, and individual service plans.
- Prepare individual records for internal reviews, quality assurance audits, surveys, and regulatory reviews.
- Correct or coordinate correction of identified documentation deficiencies within established deadlines.
- Participate in internal monitoring and quality improvement activities.
- Report patterns of noncompliance, documentation deficiencies, service gaps, or other concerns to management.
- Maintain tracking systems for required documents, expirations, annual reviews, meetings, and outstanding case-management tasks.
QUALIFICATIONS
- High school diploma or equivalent required; associate or bachelor's degree in social services, healthcare administration, psychology, sociology, human services, nursing, or a related field preferred.
- Previous experience with Texas HCS, TxHmL, IDD services, Medicaid Waiver programs, case management, residential services, or community-based services strongly preferred.
- Knowledge of person-centered planning and services for individuals with intellectual and developmental disabilities preferred.
- Familiarity with IPC, PDP, implementation plans, service authorizations, and HHSC documentation requirements is highly desirable.
- Strong organizational and time-management skills with the ability to manage multiple individuals, deadlines, and required documents.
- Strong written and verbal communication skills.
- Ability to communicate professionally with individuals, guardians, service coordinators, providers, employees, contractors, and regulatory personnel.
- Ability to identify documentation discrepancies and follow issues through resolution.
- Proficiency with Microsoft Office, electronic documentation systems, email, and electronic recordkeeping.
- Ability to maintain confidential information and comply with HIPAA requirements.
- Valid driver's license and reliable transportation may be required for visits, meetings, and other program-related responsibilities.
PREFERRED EXPERIENCE
Preference may be given to candidates with experience in one or more of the following:
- HCS or TxHmL Waiver services
- Intellectual and developmental disabilities (IDD)
- Residential Support Services (RSS)
- Supported Living (SL)
- Host Home/Companion Care
- Community First Choice (CFC)
- PAS/Habilitation services
- Individualized Skills and Socialization (ISS)
- Service coordination
- Medicaid waiver documentation
- HHSC compliance or quality assurance
- Case record auditing and service utilization monitoring
CORE COMPETENCIES
The successful HCS Case Manager should demonstrate:
Organization Accountability Documentation Accuracy Professional Communication Client Advocacy Regulatory Compliance Critical Thinking Problem Solving Time Management Team Collaboration Confidentiality Follow-Through
POSITION EXPECTATIONS
The HCS Case Manager is expected to maintain consistent oversight of assigned cases and ensure that identified concerns are addressed promptly. Case management is not limited to collecting documentation; the position requires active monitoring of the individual's services, communication among members of the interdisciplinary team, identification of potential service or compliance issues, and documented follow-through through resolution.
The Case Manager must maintain professional boundaries, protect confidential information, and consistently promote the health, safety, dignity, rights, and person-centered goals of each individual served.
Pay: $22.50 - $26.75 per hour
Benefits:
- Mileage reimbursement
- Professional development assistance
Work Location: In person
