Community Care Worker III

Texas Health & Human Services Commission•Houston, TX

16d•$35,439 - $52,388•Hybrid

About The Position

The Community Care Worker III works in the Program Support Unit (PSU) under the Medicaid CHIP Services Division. PSU facilitates STAR Kids Medically Dependent Children Program (MDCP) and STAR+PLUS Home and Community Based Services (HCBS) eligibility and enrollment for applicants and members. These programs help managed care members maintain independence in the community. The role performs moderately complex Medicaid managed care Long Term Services and Supports tasks, including frequent telephone contact with the public, members and families, Managed Care Organizations, and internal HHSC departments. Following training, staff are expected to know program policies, procedures, and software. Work involves extensive computer use, research, and interpretation of program policies and procedures. The position works under general supervision, with moderate latitude for initiative and independent judgment. The position is based in Houston and is eligible for telework in accordance with business needs and applicable agency policies. Travel is up to 10% for training and meetings.

Requirements

High school diploma or GED required.
Ability to communicate effectively orally and in writing.
Ability to manage stress in high-profile situations while maintaining a professional demeanor.
Ability to identify systemic problems and ways to resolve them.
Ability to multitask under pressure and manage workload to meet goals, objectives, and timeframes.
Customer service skills.
Ability to convey instructions and explanations, negotiate available services, and train others.
Ability to operate computer equipment and use Outlook, Excel, and Word; ability to gain a general understanding of state software programs.
Ability to identify potential problems and act proactively to prevent them.
Ability to establish priorities, set goals, and manage time efficiently.
Ability to interpret complex policy and procedure.
Ability to gather, assemble, correlate, and analyze facts to devise solutions to problems.
Ability to develop reports based on research and analysis.
Ability to perform duties with minimal supervision.
Ability to understand new or changed information and effectively relay it to others.

Nice To Haves

Experience with case management.
Experience in a position requiring time management skills.
Experience with complex policy interpretation requiring good judgment.
Knowledge of Medicaid waiver programs, policies, procedures, and eligibility processes.
Knowledge of community and government service delivery systems.
Knowledge of STAR+PLUS HCBS, MDCP, and Intellectual or Developmental Disabilities long-term care programs and services.
Knowledge of computer equipment and software including Outlook, Word, and Excel.
Knowledge of state software such as TIERS, SASO, and the TMHP Long Term Care Online Portal (LTCOP).
Skills in communicating effectively orally and in writing, managing stress in high-profile situations, identifying systemic problems, multitasking under pressure, workload management, and customer service.
Ability to use Community Services Interest Lists (CSIL) and other state software.

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 waiver programs to applicants and members.
Authorize or deny waiver services and send approval and denial notices.
Validate eligibility in appropriate systems, register waiver eligibility in the authorization system, and authorize MCOs to begin approved services.
Coordinate with MEPD staff for Medicaid enrollment, including activities for members transitioning from nursing facilities to the community.
Confirm accurate contact information, mail enrollment packets, determine appropriate MCO enrollment, and verify applicants' desire to enroll in a Medicaid waiver program.
Coordinate activities to transition individuals from a children's program to an adult waiver.
Research and troubleshoot case actions and document reasons for delays.
Address continuity-of-care issues for waiver members disenrolled from or transferred into or out of managed care service areas who experience gaps in services, including coordination with MCOs.
Assist members denied Medicaid waivers with filing state fair hearings and track and monitor the hearing process through its decision.
Prepare reports for monitoring program operations, research and resolve enrollment errors, and refer members who lose SSI eligibility to MEPD.