Community Care Worker III

Texas Health & Human Services Commission•El Paso, TX

13d•$2,953 - $4,366•Hybrid

About The Position

The Community Care Worker III serves as a specialist in the Program Support Unit, performing moderately complex work related to managed care Long Term Services and Supports (LTSS). The role involves frequent contact with Community Care Services Eligibility case managers; people enrolled in or applying for 1915(c) waiver services; service providers; LTSS managed care organizations (MCOs); relocation specialists; nursing facility staff; the public; and staff across HHSC, including MEPD, Managed Care Compliance and Operations, and Health Plan Management. The worker operates under general supervision with moderate latitude for initiative and independent judgment. The work requires operating a computer and extensive knowledge of CCSE/PSU programs and software. The role includes case management activities such as assisting people with MCO selection; approving or denying Medicaid 1115 waiver eligibility; helping people transition from nursing facilities to the community; entering or validating waiver eligibility records; notifying members of eligibility decisions; managing fair hearing requests related to denials; transferring waiver cases; and coordinating the MDCP aging-out process. The position is based in El Paso, Texas, is full-time, has a day shift, and is eligible for telework subject to state and agency policies, supervisor discretion, and business needs. Travel is up to 10%.

Requirements

High school diploma or GED.
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 emotional aspects of physical illness, disability-related needs, and community welfare resources.
Ability to communicate effectively orally and in writing with people in varied situations; convey instructions and explanations; negotiate available services; and train others.
Ability to operate computer equipment and become proficient in relevant state software programs.
Ability to manage stress in high-profile situations while maintaining a professional demeanor; identify systemic problems and potential service-delivery problems; multitask under pressure; manage workload and meet goals and timeframes; establish priorities; set goals; and manage time efficiently.

Nice To Haves

Experience with the STAR+PLUS Home and Community Based Services program, MDCP, LTSS, and/or MEPD services.
Experience with computer equipment and software, including Outlook, Word, and Excel.
Experience with state software such as 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 Medicaid 1115 waiver programs to applicants and members; authorize or deny waiver services and send notices; validate and register eligibility in appropriate systems; authorize MCOs to begin approved services; and coordinate with MEPD staff for enrollment.
Perform interest list activities, including confirming contact information, mailing enrollment packets, determining individuals’ MCO preferences, following up as needed, and confirming their wish to be assessed for a Medicaid 1115 waiver program.
Interpret policy and coordinate transitions from nursing homes to the community, transitions of children aging out of MDCP services, and transitions into and out of Medicaid 1115 waiver programs.
Contact appropriate parties to help resolve obstacles and document reasons for delays.
Address continuity-of-care issues for LTSS members who have been disenrolled or transferred into or out of managed care service areas and are experiencing a gap in services, coordinating with CCSE and MCOs as appropriate.
Assist members denied services with filing state fair hearing requests and track and monitor appeals through a decision.
Complete reports to monitor program operations, research and resolve enrollment errors, and refer members who lose SSI eligibility to MEPD.