Case Manager

Texas Health & Human Services Commission•Arlington, TX

4d•$3,095 - $4,114

About The Position

The Case Manager (Community Care Worker IV) serves as an advanced worker in the Program Support Unit performing complex tasks related to STAR Kids. The role includes helping people select a Managed Care Organization (MCO); approving or denying Medically Dependent Children Program (MDCP) waiver services; supporting transitions from nursing homes to the community; entering or validating MDCP service authorizations in automated systems; notifying members of waiver eligibility; managing fair hearings; assisting with transfers of cases involving STAR Kids; and coordinating the aging-out process for individuals enrolling in STAR+PLUS. The position frequently interacts with 1915(c) waiver recipients and applicants, service providers, STAR Kids MCOs, relocation specialists, nursing facility staff, the public, and HHSC Health Plan Management staff. Additional duties include serving as acting supervisor when the unit supervisor is absent, supervising worker and clerical staff, interpreting policy for staff, training new workers, preparing special reports, and attending or conducting meetings. The role works under general supervision with moderate latitude for initiative and independent judgment. It involves computer use and requires extensive knowledge of HHSC community programs, PSU programs, and software. The position is full-time, regular, nonexempt, and assigned to a day shift. The listed salary range is $3,095.33–$4,114.06 per month. The position is based in Arlington, Texas, may be eligible for telework subject to agency policies and business needs, and requires up to 10% travel.

Requirements

High school diploma or GED.
Knowledge of managed care 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; needs associated with disabilities; and community welfare resources.
Effective oral and written communication with people in varied situations.
Ability to explain instructions and services, negotiate available services, and train others.
Ability to operate computer equipment and proficiency with Outlook, Excel, and Word, plus a general understanding of state software such as TIERS, SAS, and CSIL.
Ability to manage stress and high-profile situations while maintaining a professional demeanor.
Ability to identify systemic problems and develop ways to resolve them; multitask under pressure; monitor performance and provide appropriate feedback; and manage workload to meet goals, prevent problems, and meet timeframes.
Ability to identify potential problems affecting service delivery and act proactively to prevent them.
Ability to communicate policies and procedures to staff, set priorities according to importance and deadlines, establish goals, and manage time efficiently.
Ability to monitor unit operations and observe and document employee performance.

Nice To Haves

Knowledge of or experience with managed care or the Medically Dependent Children Program.
Experience with Long-term Services and Supports (LTSS) or Medicaid for the Elderly and People with Disabilities (MEPD) services.
Experience or ability with computer equipment and software including Outlook, Word, Excel, TIERS, and SAS.

Responsibilities

Attend work on a regular and predictable schedule in accordance with agency leave policy and perform other duties as assigned.
Develop, coordinate, and explain STAR Kids and the MDCP waiver; authorize waiver services, send approval or denial notices, validate eligibility in TIERS and the Long-term Care Portal, authorize MCOs to start services, and authorize STAR Kids enrollment.
Provide leadership, policy interpretation, and coordination for transitions from nursing homes to the community, transitions of children into STAR+PLUS, movement into and out of STAR Kids services, and cases released from the MDCP waiver interest list.
Monitor and track services provided by contract agencies, identify problems or missed timeframes, help resolve obstacles, and document reasons for delays.
Handle continuity-of-care issues involving Long-term Services and Supports for STAR Kids members disenrolled or transferred into or out of STAR Kids areas who experience a gap in services.
Assist individuals with selecting an MCO and manage the MDCP interest list, including reviewing its accuracy and confirming individuals wish to be assessed for services.
Assist STAR Kids members denied waiver services with filing a state fair hearing and track appeals through decision.
Complete reports, research and resolve enrollment errors, make referrals for DADS services when individuals lose SSI eligibility, and prepare records on program operations.
Provide administrative assistance to the supervisor, including serving as acting supervisor, assisting with staff meetings, monitoring worker activity, and interpreting policy for staff.
Train new staff, assist the unit supervisor with reports and special case problems, and serve as a resource for difficult or complex cases.
Supervise worker and clerical staff when serving as acting supervisor.