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Community Care Worker III

3 months ago

Grand Prairie, United States Texas Department of Aging & Disability Services Full time
Job Description:
Community Care Worker III (CT)

Program Enrollment and Support (PES) is searching for new team members to join our Program Support Unit (PSU). PSU is responsible for working with our managed care members to enroll them in life changing services to maintain their independence in the community. Our positions offer an excellent benefits package and telework options after successful completion of initial training.

PSU staff perform moderately complex tasks related to Medicaid managed care Long Term Services and Supports (LTSS). Work involves frequent telephone contact with the general public, members and their families, case managers from external organizations such as Managed Care Organizations (MCOs), service providers and nursing facility staff. PSU staff will also coordinate with various internal HHSC departments such as Managed Care Compliance and Operations (MCCO) and Medicaid for the Elderly and People with Disabilities (MEPD).

Upon successful completion of training, PSU staff will have full knowledge of PSU operations and program software. Duties include assisting applicants with the eligibility and enrollment processes for Medicaid waiver programs, approve and deny eligibility for Medicaid waiver programs, provide assistance to members transitioning from a nursing facility to the community, validate and enter waiver eligibility records in authorization systems, notify members of Medicaid waiver program eligibility, manage fair hearing requests for program denials, transfer members between waiver programs, and coordinate the age out process for individuals enrolling in an adult Medicaid program. This position requires extensive computer usage, research and comprehension of program policies and procedures to successfully process cases according to PSU program policy and procedures. Staff work under general supervision with moderate latitude for the use of initiative and independent judgment.

This position will conduct all work activities from an HHSC or home office. Case management activities are not conducted via home visits.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. Develops/coordinates/explains STAR Kids and the MDCP waiver and authorizes services, such as approval and denial of waiver services, sending approval/denial notices to applicants, members and other key parties, validating eligibility in TIERS and the Long-term Care Portal, authorizing the MCO to start services, and authorizing enrollment in STAR Kids. Provides leadership, policy interpretation, and coordination for activities related to transitioning individuals from the nursing home to the community, handling the transition of children into the STAR+PLUS program, people who transition in and out of STAR Kids services, and the handling of people released from the MDCP waiver interest list. Monitors and tracks services provided by contract agencies to measure the effect of services delivered and to detect any problems. As appropriate, if timeframes are not followed by key players, contact the appropriate person to assist with resolution of obstacles and document the reason for the delay. Handle continuum of care issues related to Long-term Services and Supports (LTSS) for STAR Kids members who have been disenrolled or transferred in or out of STAR Kids areas and are experiencing a gap in services. Assist individuals in the process of selecting an MCO. Assist with management of the MDCP interest list, which includes scrubbing the list at the time of release to ensure the information is accurate and individuals wish to be assessed for MDCP services. Assist STAR Kids members who have been denied waiver services to file for a fair hearing with the State. Track and monitor appeal process through decision. Handle duties such as completing reports, researching and resolving errors in enrollment, or making referrals for DADS services for individuals who lose Supplemental Security Income (SSI) eligibility. Knowledge Skills Abilities:
PREFER THE KNOWLEDGE OF:

• Medicaid waiver programs, policies, procedures and eligibility processes.
• Community and government service delivery systems.
• Medically Dependent Children Program (MDCP), STAR+PLUS Home and Community Based Services program, IDD programs services.
• Various types of computer equipment and software including, Outlook, Word, and Excel.
• State software such as TIERS, SAS or the LTCOP.
PREFER SKILLS IN:

• Communicating effectively orally and in writing.
• Managing stress in high-profile situations while maintaining a professional demeanor.
• Identifying systemic problems and ways to resolve those problems.
• Multi-tasking under pressure.
• Managing a workload to meet goals, objectives and timeframes.
• Customer service.
PREFER THE ABILITY TO:

• Convey instructions and explanations to individuals and key parties, to negotiate available services, and to train others.
• Operate computer equipment and be proficient in the use of Outlook, Excel, Word, as well as the ability to gain a general understanding of various state software programs, e.g., TIERS, SAS and CSIL.
• Identify potential problems and act proactively to prevent the problem.
• Establish priorities according to relative importance and deadlines, set goals and manage time efficiently.
• Interpret complex policy and procedure.
• Gather, assemble, correlate, and analyze facts to devise solutions to problems.
• Develop reports based on research and analysis.
• Perform duties with minimal supervision.
• Understand new or changed information and to effectively relay that information to others.