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Community Support Specialist III

2 months ago

Grand Prairie, Texas, United States Texas Department of Aging & Disability Services Full time
Job Overview:

Community Care Worker III (CT)

The Program Enrollment and Support (PES) unit is seeking dedicated individuals to enhance our Program Support Unit (PSU).

PSU plays a crucial role in assisting managed care members to access transformative services that promote their autonomy within the community.

Our roles provide a comprehensive benefits package along with telecommuting options following the successful completion of initial training.

Staff within PSU engage in moderately complex responsibilities related to Medicaid managed care Long Term Services and Supports (LTSS).

This position involves regular communication with the public, members and their families, as well as case managers from external entities such as Managed Care Organizations (MCOs), service providers, and nursing facility personnel.

Additionally, PSU staff will collaborate with various internal departments including Managed Care Compliance and Operations (MCCO) and Medicaid for the Elderly and People with Disabilities (MEPD).


After completing training, PSU staff will possess comprehensive knowledge of PSU operations and program software.

Responsibilities encompass aiding applicants through the eligibility and enrollment processes for Medicaid waiver programs, making eligibility determinations, assisting members transitioning from nursing facilities to community settings, validating and entering waiver eligibility data into authorization systems, notifying members of their Medicaid waiver program eligibility, managing fair hearing requests for program denials, facilitating member transfers between waiver programs, and coordinating the age-out process for individuals entering adult Medicaid programs.

This role necessitates extensive computer use, research, and understanding of program policies and procedures to effectively manage cases in accordance with PSU guidelines.

Staff operate under general supervision with a moderate degree of initiative and independent judgment.

All work activities will be conducted from an HHSC or home office. Case management tasks are not performed through home visits.

Key Responsibilities:

Regularly attends work in accordance with agency leave policies and performs additional duties as assigned.

Coordinates and explains STAR Kids and the MDCP waiver, authorizing services such as waiver service approvals and denials, dispatching approval/denial notifications to applicants, members, and other relevant parties, validating eligibility in TIERS and the Long-term Care Portal, authorizing MCO service initiation, and enrollment in STAR Kids.

Provides leadership and policy guidance for activities associated with transitioning individuals from nursing homes to community settings, managing the transition of children into the STAR+PLUS program, and addressing transitions in and out of STAR Kids services.

Monitors and evaluates services provided by contracted agencies to assess service effectiveness and identify any issues.

If timelines are not adhered to by key stakeholders, contacts the appropriate personnel to facilitate resolution and documents the reasons for delays.

Addresses continuum of care challenges related to Long-term Services and Supports (LTSS) for STAR Kids members who have been disenrolled or transferred and are facing service gaps.

Assists individuals in selecting an MCO.

Manages the MDCP interest list, ensuring the accuracy of information at the time of release and confirming individuals' willingness to be assessed for MDCP services.

Aids STAR Kids members who have been denied waiver services in filing for a fair hearing with the State, tracking and monitoring the appeal process through resolution.

Handles tasks such as report completion, error resolution in enrollment, or referrals for DADS services for individuals losing Supplemental Security Income (SSI) eligibility.

Required Knowledge, Skills, and Abilities:

PREFERRED KNOWLEDGE OF:

  • Medicaid waiver programs, policies, procedures, and eligibility criteria.
  • Community and governmental service delivery frameworks.
  • Medically Dependent Children Program (MDCP), STAR+PLUS Home and Community Based Services program, and IDD program services.
  • Various computer systems and software including Outlook, Word, and Excel.
  • State software applications such as TIERS, SAS, or LTCOP.

PREFERRED SKILLS IN:

  • Effective oral and written communication.
  • Stress management in high-pressure situations while maintaining professionalism.
  • Identifying systemic issues and proposing solutions.
  • Multi-tasking in demanding environments.
  • Workload management to achieve goals and deadlines.
  • Customer service excellence.

PREFERRED ABILITY TO:

  • Convey instructions and explanations to individuals and key stakeholders, negotiate available services, and provide training to others.
  • Operate computer systems proficiently, including Outlook, Excel, and Word, and gain a general understanding of various state software programs, e.g., TIERS, SAS, and CSIL.
  • Identify potential issues and take proactive measures to prevent them.
  • Prioritize tasks based on importance and deadlines, set objectives, and manage time effectively.
  • Interpret complex policies and procedures.
  • Gather, organize, correlate, and analyze information to develop solutions to problems.
  • Generate reports based on research and analysis.
  • Perform duties with minimal oversight.
  • Comprehend new or modified information and effectively communicate that information to others.