PCS and CFC Team Lead

4 weeks ago

Austin, United States Texas Department of Aging & Disability Services Full time
Job Description:
The Program Policy team within Medicaid and CHIP Services (MCS) Office of Policy is seeking a highly qualified candidate to fill the position of Policy Advisor (Program Specialist VI) and serve as a team lead on subject matter areas related to Medicaid and CHIP managed care policy. This position performs highly advanced, consultative and technical work related to the planning, development, implementation, and maintenance of Medicaid and CHIP program policy.

The Policy Advisor:

• Provides subject-matter expertise to agency staff, governmental agencies, community organizations, provider organizations, and the general public;
• May serve as the lead on implementation and ongoing management of complex program initiatives;
• Collaborates with and provides technical assistance and oversight for Department of State Health Services (DSHS) Regional Specialized Health and Social Services (SHSS) case management and liaison staff;
• Requires in-depth knowledge of: Medicaid; Personal Care Services; Early and Periodic Screening, Diagnostic, and Treatment/Texas Health Steps Program; Supplemental Security Income; Department of Family and Protective Services programs; and other HHS System programs.

The Policy Advisor will also:

• Provide consultative and technical work related to the planning, development, implementation, and maintenance of Personal Care Services and Community First Choice services for children up to 20 years of age;
• Identify and leverage subject matter expertise to identify and propose solutions to program needs;
• Coordinate and collaborate with internal and external stakeholders to develop policy;
• Oversee the development of operational policy, including contract, administrative rule, manual, and procedural requirements;
• Help ensure compliance with program policies and procedures, statutes, and rules and oversee and/or participate in issue resolution;
• Lead meetings with multiple stakeholders, including managed care organizations, provider associations, people receiving services, and advisory committee members;
• Serve as agency liaison to pertinent advisory committees or workgroups;
• Develop program policies, procedures, standards, and manuals;
• Prepare high quality written reports, correspondence, and other documents;
• Draft legislative reports;
• Develop and provide training; and
• Analyze program policies and legislation.

The position is not supervisory but may assign, oversee, and prioritize work of others. The position will work under limited supervision, with considerable latitude for the use of initiative and independent judgment. This position reports to a Manager for Program Policy in the Office of Policy, Medicaid and CHIP Services.
Essential Job Functions:
(20%) Provides policy development and oversight for case management providers and DSHS regional staff. Develops and updates policy and procedure manuals and related forms for Personal Care Services/Community First Choice in accordance with program objectives and goals. Provides technical assistance to providers and DSHS regional managers on policy implementation and clarification. Reviews and updates, as needed, rules and the Texas Medicaid Provider Procedure Manual. Analyzes legislation to develop recommendations for policy and programmatic issues relating to implementation, improvement, and program funding.

(20%) Provides guidance and consultative services to providers and DSHS regional staff in the development and integration of new methods and procedures, and to plan and monitor the effectiveness of agency programs. Collects, organizes, analyzes, and prepares material in response to requests for information and reports.

(15%) Ensures client eligibility by establishing service criteria. Approves/denies prior authorizations or gives guidance in the authorization of the level of service for programs. Receives and processes referrals for Community First Choice Program. Problem solves billing issues with case management providers and PCS/CFC case managers through Medicaid leadership or contractors.

(15%) Investigates and resolves complaints from and communicates outcomes to DSHS regional staff, Medicaid providers, clients and families, Medicaid leadership, Office of Ombudsman, and community members. Examines trends and establishes corrective measures as appropriate. Liaisons with appropriate investigatory agencies.

(10%) Plans, organizes, and implements training/ongoing education for providers and DSHS regional staff in accordance with program objectives and goals. Provides technical assistance to DSHS regional staff to assist in planning/developing educational programs on PCS/CFC.

(5%) Engages with community groups to coordinate, improve, and promote programs. Speaks to participants in statewide professional conferences for the purpose of program education, outreach, and provider recruitment.

(5%) Serves as a liaison with various programs/units in HHSC, DSHS Regional SHSS, Department of Family and Protective Services, state and national organizations, and professional licensing boards related to programs.

(5%) Prepares high quality written documents, including program and project updates, memos, summaries, legislative reports, rules, waivers, state plan amendments, and other documents.

(5%) Conducts special projects, initiatives, directives, or duties as assigned in support of HHSC division, department, unit, or section. Other duties as assigned.
Knowledge Skills Abilities:
Knowledge of:

• Federal and state Medicaid and CHIP laws and regulations;
• Legislative process and experience analyzing legislative bills;
• Government organization and administration; and
• MCS and HHSC processes related to the administration or provision of Medicaid and CHIP benefits.
• Policy development and research methods.

Skills in:

• Analyzing and evaluating complex federal and state legislation, program policy, and operations issues;
• Researching with regard to Medicaid policy;
• Developing and implementing creative and workable solutions to complex problems;
• Translating policy and technical information into easily understandable and concise documents and oral presentations;
• Using Microsoft Office products, including SharePoint and Teams;
• Developing creative and workable solutions to complex problems and policy issues; and
• Facilitating meetings with external stakeholders and other project or agency partners.

Ability to:

• Work cooperatively as a team member in a fast-paced, deadline-oriented environment.
• Work with a team under pressure, negotiate with multiple parties, and resolve conflicts;
• Establish and maintain effective working relationships with various levels of personnel in government entities;
• Exercise judgement and work independently with minimum supervision;
• Serve as lead staff and provide effective direction to other staff.
• Communicate effectively orally and in writing.

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