Community Care Worker III

Texas Health & Human Services Commission•Harlingen, TX

13d•$2,953 - $4,366•Hybrid

About The Position

The Texas Health and Human Services Commission’s Program Enrollment and Support Unit (PSU), within Medicaid CHIP Services, facilitates eligibility and enrollment for STAR Kids Medically Dependent Children Program (MDCP) and STAR+PLUS Home and Community Based Services (HCBS). These programs help managed care members maintain independence in the community. PSU staff perform moderately complex Medicaid managed care Long-Term Services and Supports work, with frequent telephone contact with the public, members, families, and external organizations such as Managed Care Organizations (MCOs). Staff also coordinate with internal HHSC departments, including Managed Care Compliance and Operations and Medicaid for the Elderly and People with Disabilities. After training, the worker applies program policies, procedures, and software to assist applicants with Medicaid waiver eligibility and enrollment, approve or deny eligibility, support transitions from nursing facilities to community settings, validate and enter eligibility records, notify members of decisions, manage fair hearing requests, transfer members between waiver programs, and coordinate transitions from children’s programs to adult waivers. The role requires extensive computer use, research, and interpretation of policies and procedures. Work is performed under general supervision, with moderate latitude for initiative and independent judgment. The position is full-time, nonexempt, and based in Harlingen, Texas. It is a day-shift role with telework eligibility subject to business needs and agency policies. Travel is up to 10%. The posted monthly salary range is $2,953.25 to $4,365.66.

Requirements

High school diploma or GED required.
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 IDD long-term care programs and services.
Knowledge of computer equipment and software, including Outlook, Word, and Excel, and state systems such as TIERS, SASO, and the TMHP Long Term Care Online Portal.
Ability to communicate effectively orally and in writing; manage stress professionally; identify systemic problems and potential solutions; multitask under pressure; manage workload to meet goals and deadlines; and provide customer service.
Ability to explain instructions and information, negotiate available services, and train others.
Ability to operate computer equipment and use Outlook, Excel, and Word, and to learn state software such as TIERS, SASO, and CSIL.
Ability to identify potential problems proactively; prioritize by importance and deadlines; set goals and manage time; interpret complex policy and procedure; gather and analyze facts to solve problems; develop research-based reports; work with minimal supervision; and understand and relay new or changed information.

Nice To Haves

Experience with case management.
Experience in a position requiring time-management skills.
Experience interpreting complex policies with good judgment.

Responsibilities

Attend work regularly and predictably 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; send notices; validate eligibility; register eligibility in authorization systems; authorize MCOs to begin approved services; and coordinate Medicaid enrollment with MEPD staff, including for members transitioning from nursing facilities to the community.
Confirm interest-list contact information, mail enrollment packets, determine appropriate MCO enrollment, and verify applicants’ desire to enroll in a Medicaid waiver program.
Coordinate transitions from a children’s program to an adult waiver through age-out activities.
Research and troubleshoot case actions and document reasons for delays.
Address continuity-of-care issues for waiver members who have been disenrolled or transferred into or out of managed-care service areas and are experiencing gaps in services, including coordination with MCOs.
Assist members denied Medicaid waivers with filing state fair hearings and track and monitor the process through its decision.
Prepare reports to monitor program operations, research and resolve enrollment errors, and refer members who lose SSI eligibility to MEPD.