Community Support Specialist III

2 weeks 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 actively seeking dedicated individuals to enhance our Program Support Unit (PSU).

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

Our roles provide a comprehensive benefits package and flexible telework arrangements following the successful completion of initial training.

PSU personnel engage in moderately complex responsibilities associated with Medicaid managed care Long Term Services and Supports (LTSS).

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

PSU staff will also collaborate with various internal departments within HHSC, 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, determining eligibility for these programs, assisting members transitioning from nursing facilities to community settings, validating and entering waiver eligibility data into authorization systems, notifying members regarding their Medicaid waiver program eligibility, managing fair hearing requests for program denials, facilitating transfers between waiver programs, and coordinating the age-out process for individuals transitioning to adult Medicaid programs.

This role necessitates extensive computer usage, 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 autonomy and independent judgment.

This position entails conducting all work activities from an HHSC or home office. Case management activities are not performed through home visits.

Key Responsibilities:

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

Develops, coordinates, and explains STAR Kids and the MDCP waiver, authorizing services such as approval and denial of waiver services, dispatching approval/denial notifications to applicants, members, and other relevant parties, validating eligibility in TIERS and the Long-term Care Portal, authorizing MCOs to initiate services, and facilitating enrollment in STAR Kids.

Provides leadership, policy interpretation, and coordination for activities related to transitioning individuals from nursing homes to community settings, managing the transition of children into the STAR+PLUS program, and overseeing individuals transitioning in and out of STAR Kids services.

Monitors and evaluates services provided by contracted agencies to assess the impact of services delivered and identify any issues.

If timelines are not adhered to by key stakeholders, contacts the appropriate individuals to assist in resolving obstacles 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 in or out of STAR Kids areas 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' desire 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 compiling reports, investigating and resolving enrollment errors, or referring individuals for DADS services when they lose 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 systems.
  • 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 such as TIERS, SAS, or LTCOP.

PREFERRED SKILLS IN:

  • Effective oral and written communication.
  • Managing stress in high-pressure situations while maintaining professionalism.
  • Identifying systemic issues and proposing solutions.
  • Multi-tasking in demanding environments.
  • Managing workloads to achieve goals, objectives, and deadlines.
  • Providing excellent customer service.

PREFERRED ABILITY TO:

  • Convey instructions and explanations to individuals and key stakeholders, negotiate available services, and train others.
  • Operate computer systems proficiently, including Outlook, Excel, and Word, and quickly learn 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 goals, and manage time effectively.
  • Interpret complex policies and procedures.
  • Gather, assemble, correlate, and analyze information to develop solutions to problems.
  • Create reports based on research and analysis.
  • Perform tasks with minimal supervision.
  • Understand new or revised information and effectively communicate that information to others.

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