Program Specialist IV

Job Description:
Program Specialist IV will provide highly complex consultative and technical assistance, including research, assessment and planning directly to management, IDD Program Eligibility and Support (IDD PES) department colleagues and HHSC staff from other agency organizational areas, Local Intellectual and Developmental Disability Authority (LIDDA) staff, Community Living Assistance and Support Services (CLASS), and Community First Choice (CFC) Non-Waiver, Deaf Blind with Multiple Disabilities (DBMD) advocacy groups, stakeholders, program participants and their families. Work involves Level of Care (LOC) eligibility determinations for individuals who receive services in the CLASS Waiver Program and Community First Choice (CFC) Non-Waiver program. Work also involves the oversight and monitoring of provider requirements with enrollment activities, such as initial Individual Plans of Care (IPC) and Level of Care(LOC) determinations. Routinely reviews and analyzes Intellectual Disability/Related Condition (ID/RC) data to assess the need for additional oversight. Conducts desk reviews to determine compliance with HHSC rules, policies and procedures related to program enrollment, including IPCs and LOCs. Conducts initial ID/RC and DBMD and CLASS proposed enrollment IPC reviews to make authorization decisions regarding participant eligibility and plan of care approvals. Evaluates IPC and eligibility activities and trends to resolve technical problems, identifies opportunities for improvement and makes recommendations for improvements in review processes. Conducts analysis of data and reports as assigned, and collects, organizes, analyzes and prepares materials in response to requests for program information, or special project reports. Develops and revises review tools (e.g., review protocols, evaluation forms, etc.) in accordance with program objectives and goals. Serves as agency representative to present the state’s action in Medicaid fair hearings. Conducts training and provides guidance to staff in the development or integration of new or revised operational procedures.
Coordinates the review and evaluation of information on service delivery system methods, outputs and activities in order to identify gaps in resources and recommend improvements. Coordinates and collaborates with program staff through participation in unit and cross-agency workgroups related to unit functions and planning to analyze, develop, and implement program initiatives. Works under limited supervision with considerable latitude for the use of initiative and independent judgment.
 

Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
Provides highly complex consultative and technical assistance, including research, assessment and planning directly to management, HHSC program staff, HHSC contract management staff, local intellectual developmental disability authority (LIDDA) staff, the program provider base, advocacy groups, stakeholders, program participants and their families. (10%)
Oversees and monitors provider requirements with enrollment Individual Plans of Care (IPC) and Level of Care (LOC) eligibility determinations. (50%)
Conducts analysis of data and reports as assigned, and collects, organizes, analyzes and prepares materials in response to requests for program information, or special project reports. (5%)
Serves as agency representative in fair hearings. (5%)
Develops and revises review tools (e.g., review protocols, evaluation forms, etc.) in accordance with program objectives and goals. (5%)
Conducts training and provides guidance to staff in the development or integration of new or revised operational procedures. (10%)
Coordinates and collaborates with program staff through participation in unit, agency and cross-agency workgroups related to unit functions and planning to analyze, develop, and implement program initiatives. (10%)
Will serve as the lead to prioritize the work of colleagues by assigning provider deliverables to designated unit staff during the absence of the supervisor. (5%)
 

Knowledge Skills Abilities:
Knowledge of intellectual disability and other developmental disability related conditions, CLASS and CFC, program rules, service array and billing guidelines, local authority functions and waiver service system.
Knowledge of federal and state laws relating to long term care and other Medicaid and non-Medicaid services and programs.
Knowledge of program planning, implementation, and evaluation and continuous quality improvement.
Skill in the development and maintenance of interpersonal relationships and public speaking. Ability to communicate effectively, both orally and in writing.
Ability to gather, assemble, correlate, and analyze information to devise solutions to problems.
Ability to interpret policies and procedures.
Ability to multi-task, handle stress, and meet deadlines.
Ability to make appropriate determinations using specific criteria.
Ability to independently plan, organize, prioritize and manage multiple work assignments.
Ability to operate computers and experience using Microsoft Office products.

Initial Selection Criteria:

Experience with Medicaid services for individuals with intellectual and/or developmental disabilities is required.

Experience in interpreting policies and procedures is preferred.

Experience with eligibility criteria for the 1915c Waiver programs, ICFs/SSLCs, and/or CFC Non-Waiver program.

Registration or Licensure Requirements:
Qualification as a Qualified Intellectual Disability Professional (QIDP) as defined in 42 Code of Federal Regulations 483.430(a) required.