Program Specialist VI

TX-HHSC-DSHS-DFPS•Austin, TX

1d•$5,099 - $8,305•Hybrid

About The Position

The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Program Specialist V. MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution to MCS’s mission by providing oversight and monitoring of provider requirements with Individual Plans of Care (IPC), enhanced staffing rate requests for Individualized Skills and Socialization services, and Level of Care/Level of Need (LOC/LON) determinations. This position performs highly advanced (senior-level) consultative services and technical assistance Work involves planning, developing and implementing departmental and agency programs and providing consultative services and technical assistance to HHSC program staff, HHSC management staff, contracted entities, local intellectual and developmental disability authority (LIDDA) staff, the Home and Community-based Services (HCS), Texas Home Living (TxHmL), and Intermediate Care Facility (ICF/ID) provider base, advocacy groups, stakeholders, and program participants and their families. Serves as lead worker providing direction to reviewers completing desk reviews of Individual Plans of Care (IPC) and Levels of Need (LON) in compliance with HHSC rules, policies and procedures related to IPCs and LONs. Assists in preparation of hearing packets and scripts and attends fair hearings to support reviewers or cover hearings when staff are not available. Evaluates IPC and LON submissions to provide analysis of trends to resolve technical problems, identify opportunities for improvement and to make recommendations for improvements in utilization review processes. Staffs cases and reviews correspondence for reviewers and nurses. Works under minimal supervision, with considerable latitude for the use of initiative and independent judgment. The ideal candidate thrives in an environment that emphasizes teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy. This position reports to the Director of Utilization Management and Review, working cases with the HCS/TxHmL desk review team.

Requirements

Qualification as a Qualified Intellectual Disability Professional (QIDP) as defined in 42 Code of Federal Regulations 483.430(a) required.
Graduation from an accredited four-year college or university with a degree in human services or a related field.
A minimum of one year of experience with individuals with intellectual/development disabilities or related conditions required.
At least one year of experience of utilization review and / or HCS, TxHmL, CLASS, DBMD and / or ICF/ID program rules, service array and billing guidelines, local authority functions and waiver service system.

Nice To Haves

Knowledge of the field from graduation from an accredited four-year college or university with a degree in human services or a related field with a minimum of one year of experience with individuals with intellectual/development disabilities or related conditions required (to meet the requirements of a QIDP).
Knowledge of utilization review and / or HCS, TxHmL, CLASS, DBMD and ICF/ID program rules, service array and billing guidelines, local authority functions and waiver service system.
Awareness of federal and state laws relating to long term care and other Medicaid and non-Medicaid services and programs.
Knowledge of program planning, implementation and evaluation and continuous quality improvement.
Skill in the development and maintenance of interpersonal relationships and public speaking.
Ability to communicate effectively, both orally and in writing.
Ability to interpret statistical information.
Ability to gather, assemble, correlate, and analyze information; to devise solutions to problems; to prepare reports; to develop, evaluate, and interpret policies and procedures; to train, lead, and/or prioritize the work of others.
Ability to multi-task, handle stress and meet deadlines.
Ability to operate computers and experience using Microsoft Office products.

Responsibilities

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
Plans, prioritizes, and performs a variety of technical assistance, training, research, planning, policy, program assessment, and administrative duties directly in cooperation with HHSC management, HHSC program staff, HHSC contracted entities, local intellectual and developmental disability (LIDDA) staff, the program provider base, advocacy groups, stakeholders, program participants and their families. (40%)
Oversees, monitors, prioritizes, and assures the work of others is in compliance with provider requirements for Individual Plans of Care (IPC) and Levels of Need (LON) and may perform work of reviewer as departmental workload demands require. (25%)
Coordinates the collection, organization, and analysis of data and prepares presentations and reports as assigned in response to requests for program information, special projects, and departmental needs. (5%)
Serves as agency subject matter specialist in Medicaid fair hearings. (5%)
Development and maintenance of utilization review tools and systems in accordance with program objectives and goals. (5%)
Conducts training and provides guidance to staff in the development or integration of new or revised operational procedures. (10%)
Participation in unit, agency and cross-agency workgroups related to unit functions and planning to analyze, develop, and implement program initiatives; may serve as the lead on an initiative when requested. (5%)
Directs work of other reviewers during the absence of the supervisor. (5%)