Community Care Worker 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.

Job Description:

Program Enrollment and Support (PES) is searching for new team members to join our Program Support Unit (PSU). PSU is responsible for working with our managed care members to enroll them in life changing services to maintain their independence in the community. Our positions offer an excellent benefits package and telework options after successfully completing initial training.  

PSU staff perform moderately complex tasks related to Medicaid managed care Long Term Services and Supports (LTSS). Work involves frequent telephone contact with the general public, members and their families, case managers from external organizations such as Managed Care Organizations (MCOs), service providers and nursing facility staff. PSU staff will also coordinate with various internal HHSC departments such as Managed Care Compliance and Operations (MCCO) and Medicaid for the Elderly and People with Disabilities (MEPD).

Upon successful completion of training, PSU staff will have full knowledge of PSU operations and program software. Duties include assisting applicants with the eligibility and enrollment processes for Medicaid waiver programs, approve and deny eligibility for Medicaid waiver programs, provide assistance to members transitioning from a nursing facility to the community, validate and enter waiver eligibility records in authorization systems, notify members of Medicaid waiver program eligibility, manage fair hearing requests for program denials, transfer members between waiver programs, and coordinate the age out process for individuals enrolled in a children’s Medicaid program. This position requires extensive computer usage, research and comprehension of program policies and procedures to successfully process cases according to PSU program policy and procedures. Staff work under general supervision with moderate latitude for the use of initiative and independent judgment.

This position will conduct all work activities from an HHSC or home office. Case management activities are not conducted via home visits.

Essential Job Functions:

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.  

Develop, coordinate, and explain waiver programs to applicants and members. Authorize or deny waiver services, send approval and denial notices. Validate eligibility in appropriate systems. Register waiver program eligibility in authorization system, authorize MCOs to begin approved services. Coordinate with MEPD staff for enrollment in Medicaid. This includes activities for members transitioning out of nursing facilities to the community. (50%)

Perform interest list activities such as confirming accurate contact information, mail enrollment packets, determine appropriate MCO enrollment and verify applicants desire to enroll in a Medicaid waiver program. (10%) 

Perform age out activities by coordinating activities related to transitioning individuals from a children’s program to an adult waiver. (10%) 

Research and trouble-shoot case actions and document delay reasons. (5%)

Handle continuum of care issues related to 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 MCO’s. (10%) 

Assist denied Medicaid waiver members to file a fair hearing with the state. Track and monitor the fair hearing processes through to the decision.  (5%) 

Handle other duties such as reports for monitoring program operations, research and resolve errors in enrollment and make referrals to MEPD for members who lose Supplemental Security Income (SSI) eligibility. (10%)

Knowledge, Skills and Abilities:

KNOWLEDGE OF:

• Medicaid waiver programs, policies, procedures and eligibility processes.
• Community and government service delivery systems.
• STAR+PLUS Home and Community Based Services program, Medically Dependent Children Program (MDCP), IDD programs services.
• Various types of computer equipment and software including, Outlook, Word, and Excel. 
• State software such as TIERS, SAS or the LTCOP. 

SKILLED IN:

• Communicating effectively orally and in writing.
• Managing stress in high-profile situations while maintaining a professional demeanor.
• Identifying systemic problems and ways to resolve those problems.
• Multi-tasking under pressure.
• Managing a workload to meet goals, objectives and timeframes.
• Customer service. 

ABILITY TO:

• Convey instructions and explanations to individuals and key parties, to negotiate available services, and to train others.
• Operate computer equipment and be proficient in the use of Outlook, Excel, Word, as well as the ability to gain a general understanding of various state software programs, e.g., TIERS, SAS and CSIL. 
• Identify potential problems and act proactively to prevent the problem.
• Establish priorities according to relative importance and deadlines, set goals and manage time efficiently.
• Interpret complex policy and procedure.
• Gather, assemble, correlate, and analyze facts to devise solutions to problems.
• Develop reports based on research and analysis.
• Perform duties with minimal supervision.
• Understand new or changed information and to effectively relay that information to others.

Registrations, Licensure Requirements or Certifications:         NONE  

Initial Screening Criteria: 

• High School Diploma or GED required.
• Prefer experience with case management.
• Prefer experience in a position requiring time management skills.
• Prefer experience with complex policy interpretation requiring good judgement.

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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

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.