Community Care Worker IV

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.

Job Description:

Open to current STAR+PLUS HCBS staff.  

Serves as an advanced specialist in the Program Support Unit (PSU) performing 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 eligiblity 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 eligiblity 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, and Medicaid for the Elderly and People with Disabilities (MEPD) staff. Additional duties include serving as acting supervisor in the absence of the unit supervisor, providing assistance and policy interpretation to staff, training new specialists, completing special reports, and attending and conducting meetings such as Community Transition Team (CTT) meetings. 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.

(10%) 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 eligibilitly in authorization systems, authorizing the MCO to begin services, coordinating with MEPD staff, and authorizing enrollment in a Medicaid 1115 Waiver program. (35%) 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. (20%)  Provides administrative assistance to the supervisor, which may include serving as acting supervisor, assisting in conducting staff meetings, and monitoring worker activity.  Assists staff with the interpretation of policy. Assists in training new staff.  Assists the unit supervisor in completing reports or resolving special case problems. Serves as a resource person for more difficult or complex cases. (10%) Provides leadership, 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 Long Term Services and Supports 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 Community Care Eligibility Services (CCES), as appropriate.  (10%) 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 and 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 communicate policies and procedures to staff. 
• Ability to establish priorities according to relative importance and deadlines, set goals, and manage time efficiently. 
• Ability to monitor unit operations. 
• Ability to observe employee performance and record observations.

Initial Screening Criteria: 

High School Diploma or GED required. Preferred experience with Medicaid 1115 Waiver programs, LTSS, and experience with MEPD services. Effective written and oral communication skills as demonstrated on the application. Experience with various types of computer equipment and software including, Outlook, Word, Excel, TIERS and SAS. 

Registrations, Licensure Requirements or Certifications:

N/A

Additional information:

Telework opportunities are available in accordance with business need. Telework privileges are also subject to change under MCS direction.

Only applications with the job experience completed on the application will be considered.

The posted salary range reflects the minimum and maximum allowable by state law. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC. 

Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC.

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

Telework Disclaimer:

This position may be eligible for telework.  Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.