Ombudsman III

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.

This position will telework 100% from anywhere in Texas. Under the direction of the Manager of the Specialized Ombudsman Services in the HHS Office of the Ombudsman, the Ombudsman III assists in planning, development and implementation of a comprehensive complaint management system for the Office of the Ombudsman. Performs complex complaint resolution work; provides consultation, technical services, facilitation, extensive coordination and problem solving related to HHS agencies and services; maintains a caseload; handles legislative complaints and inquiries; completes high level complaint research and resolution for Commissioner Office assignments; and evaluates adherence to contracts, policies, procedures and guidelines to ensure consistency with HHS program requirements. Interfaces directly with clients, U.S. and State legislative officials, the Executive Commissioner's Office, federal agencies, advocacy groups, and HHS Departments. Works with Ombudsman Office staff to identify trends in complaint reporting relative to HHS programs. Works under general supervision with moderate latitude for the use of initiative and independent judgment.

Essential Job Function:

EJF 1. On a daily basis, provide courteous and professional service on all complex complaints from HHS clients, providers, other HHS program areas, legislative officials, federal agencies, the Executive Commissioner's office, the Governor’s office, advocacy groups, and other stakeholders.  Handle escalated issues from Ombudsman I and II staff. Resolve complex complaints by:

•  Performing in-depth analysis of complex complaints which includes: researching and interpreting state and federal rules and regulations, agency procedures, and client rights and responsibilities via Uniform Managed Care Manual, Medicaid Managed Care (MMC) contracts, HHS MMC handbooks, Texas Works and MEPD Handbooks, state and federal statutes and Texas Administrative Code; interpreting client specific information in HHS and vendor eligibility and enrollment systems, and researching the internet; and determining whether a complaint may be handled within the initial contact or requires investigation.

•  Seeking guidance of subject matter specialists from other state or federal agencies.

•  Conducting investigations by interviewing and making requests for information and/or documentation from complainants, HHS program areas, providers, vendors, and Managed Care Organizations (MCO), and from any other party involved in the investigation.

•  Facilitating the sharing of information among various parties involved in a dispute. Coordinating with providers, HHS program areas, MCOs, advocacy organizations, HHS vendors, other state agencies, federal agencies, legislative offices, the Executive Commissioner’s office, and/or local resources to mediate HHS client issues and complaints and generate options for resolution. 

•  Analyzing results of investigations. Making determinations regarding program and policy compliance, preparing findings, and ensuring resolution of issue/complaint.

•  Providing accurate and appropriate information and referrals to HHS entities, other state agencies, and local resources.

•  Educating and advising stakeholders on HHS policies, procedures, state and federal rules and regulations, Fair Hearing and appeal process, empowering HHS clients to navigate the HHS system and advocate for themselves when possible, and submitting Fair Hearings on behalf of clients. (45%)

EJF 2. On a daily basis, accurately and thoroughly document all issues, actions, analysis, findings, and resolution in the Ombudsman database. Respond in writing via email, fax, or formal letters with HHS clients, HHS program areas, HHS vendors, providers, MCOs, advocacy organizations, legislative officials and the Executive Commissioner’s office and prepare additional materials when warranted. Write detailed investigation reports for the Director and/or Executive Commissioner. (20%)

EJF3. On open investigations, follow up regularly with the client and other parties involved in the issue/complaint; track and prompt to ensure timely and complete responses; and report late responses on referred issues to management within specified timeframes. (25%)

EJF4. Report to Ombudsman management recurring issues and problem trends that may affect the administration of HHS programs management, with recommendations for improvement to include HHS policy/procedure changes, changes to TAC, or vendor contract changes. (5%)

EJF5. In the absence of the Program Supervisor VI, advise staff on difficult cases and assign work to Ombudsmen. Represent the office at meetings/workgroups. Assist in training new Ombudsmen (5%)    

Knowledge Skills Abilities:

a) Knowledge of applicable state and federal laws, regulations, and policies relevant to Medicaid and Medicaid Managed Care benefits and Health and Human Services programs, services and procedures.

b) Ability to interpret, analyze, and evaluate complex program policy and rules and regulations and make accurate assessments.

c) Ability to determine complexity of issue and address issue with appropriate agency or program.

d) Skill in the use of computers and related equipment and software, including Windows, Word, Excel, Outlook, and database software.

e) Skill in communicating effectively, both verbally and in writing.

f) Ability to meet tight deadlines.

g) Skill in establishing and maintaining effective working relationships, including the ability to work with people under pressure.

h) Ability to work on an Automated Call Distribution (ACD) hotline.

i) Skill in using eligibility and claims databases.

j) Skill in conducting research using internet and other sources, investigating complaints, recognizing problems and facilitating solutions, in complaint resolution.

k) Ability to use an automated tracking system.

l) Ability to work and communicate with individuals in personal crises and in confrontative situations as evidenced by the ability to maintain control of an interview.

m) Ability to elicit factual information or perform required duties in order to proceed with an investigation.

n) Skill in mediation and conflict resolution.

o) Ability to interact with all clients, internal and external, using empathy and compassion.

p) Ability to coordinate with other staff, departments, officials, agencies, organizations, and the public.

q) Ability to organize and prioritize workload and perform work on own initiative

Registrations, Licensure Requirements or Certifications:

None

Initial Screening Criteria: 

A minimum of two years’ experience within the past three years in Texas Works SNAP, Medicaid, TANF, or Medicaid for the Elderly and People with Disabilities (MEPD) policy. Experience investigating and resolving moderate to complex health and human services complaints (e.g. benefit issuance/services). Experience interpreting and applying agency, state, and federal rules, regulations, policies, and procedures. Experience working with TIERS and HHS systems. Ombudsman experience preferred. Graduation from an accredited four-year college university with major course work in business administration, psychology, or sociology, or related field is generally preferred. 

Additional Information

In-basket required along with interview. May be required to work hours other than 8 am to 5 pm, such as until 5:30 pm.

Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits, follow HHS salary administration policy and guidelines and based on the candidate’s qualifications.

Employee will telework 100% from anywhere in Texas, consistent with HHS telework policies. Employees are responsible for providing the necessary infrastructure for working at home, including office furnishings (desk, chair, lamps, etc.), and utilities (reliable internet, electricity, telephone). The agency will not reimburse for utilities, or any items purchased for use at home, including office supplies, internet service, or maintenance or repair of personally owned equipment. Travel to a regional HHS office for pick up or repair of HHS-issued equipment may be required. 

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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.

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS 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.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form