Program Support Case Manager

Texas Health & Human Services Commission•Grand Prairie, TX

4d•$2,953 - $3,659

About The Position

The Program Support Case Manager works in the Program Support Unit (PSU) within Program Enrollment and Support (PES), Medicaid CHIP Services Division, Texas Health and Human Services Commission. PSU facilitates eligibility and enrollment for the STAR Kids Medically Dependent Children Program (MDCP) and STAR+PLUS Home and Community Based Services (HCBS), which help managed care members maintain independence in the community. The position performs moderately complex work related to Medicaid managed care Long Term Services and Supports (LTSS), with frequent telephone contact with applicants, members, families, and staff from external organizations such as Managed Care Organizations (MCOs). The role also coordinates with internal HHSC departments, including Managed Care Compliance and Operations (MCCO) and Medicaid for the Elderly and People with Disabilities (MEPD). After training, the employee applies program operational policies, procedures, and software to assist applicants with Medicaid waiver eligibility and enrollment, make eligibility decisions, support transitions from nursing facilities to the community, maintain 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 work requires extensive computer use, research, and comprehension of program policies and procedures. The position works under general supervision, with moderate latitude to use initiative and independent judgment.

Requirements

High school diploma or GED.
Extensive computer use and the ability to research and comprehend program policies and procedures.
The ability to perform case-processing duties according to PSU program policies and procedures.
No registration, licensure, or certification is required.

Nice To Haves

Experience with case management.
Experience in a position requiring time-management skills.
Experience interpreting complex policies with 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 (IDD) long-term care programs and services.
Knowledge of computer equipment and software such as Outlook, Word, and Excel, and state systems such as TIERS, SASO, or the TMHP Long Term Care Online Portal (LTCOP).
Effective oral and written communication skills.
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, and to learn state software such as TIERS, SASO, and Community Services Interest Lists (CSIL).
Ability to identify potential problems and act proactively to prevent them.
Ability to prioritize work according to importance and deadlines, set goals, and manage time efficiently.
Ability to interpret complex policy and procedure, gather and analyze facts, develop solutions, and prepare reports based on research and analysis.
Ability to perform duties with minimal supervision and understand and communicate new or changed information.

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; send approval and denial notices; validate eligibility in appropriate systems; register waiver eligibility in authorization systems; authorize MCOs to begin approved services; and coordinate Medicaid enrollment with MEPD, including transitions from nursing facilities to the community.
Perform interest list activities, including confirming contact information, mailing enrollment packets, determining appropriate MCO enrollment, and verifying applicants’ interest in enrolling in a Medicaid waiver program.
Coordinate age-out activities for individuals transitioning from a children’s program to an adult waiver.
Research and troubleshoot case actions and document reasons for delays.
Handle continuity-of-care issues for waiver members disenrolled from or transferred into or out of managed care service areas who experience a gap in services, including coordinating with MCOs.
Assist members denied Medicaid waivers in filing state fair hearings and track and monitor the hearing process through its decision.
Prepare reports to monitor program operations, research and resolve enrollment errors, and refer members who lose Supplemental Security Income (SSI) eligibility to MEPD.