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

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

Our roles come with a comprehensive benefits package and options for remote work 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 work entails regular communication via telephone 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 personnel will collaborate with various internal departments within HHSC, including Managed Care Compliance and Operations (MCCO) and Medicaid for the Elderly and People with Disabilities (MEPD).


Upon completing training, PSU staff will possess comprehensive knowledge of PSU operations and relevant 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, informing members of their Medicaid waiver program eligibility, managing fair hearing requests for program denials, facilitating transfers between waiver programs, and coordinating the transition process for individuals aging out of children's Medicaid programs.

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

Staff operate under general supervision with considerable latitude for initiative and independent judgment.

This position entails conducting all work activities from an HHSC or home office, with case management tasks not performed through home visits.

Key Responsibilities:

Maintain regular and predictable attendance in alignment with agency leave policies and perform additional duties as assigned.

Develop, coordinate, and articulate waiver programs to applicants and members. Authorize or deny waiver services, dispatch approval and denial notifications. Validate eligibility within the appropriate systems. Register waiver program eligibility in the authorization system, and authorize MCOs to initiate approved services. Collaborate with MEPD staff for Medicaid enrollment, particularly for members transitioning from nursing facilities to community living. (50%)

Execute interest list activities, including confirming accurate contact details, mailing enrollment packets, determining suitable MCO enrollment, and verifying applicants' intentions to enroll in a Medicaid waiver program.

(10%)

Manage age-out activities by coordinating the transition of individuals from children's programs to adult waivers.

(10%)

Investigate and resolve case actions, documenting reasons for any delays. (5%)

Address continuum of care issues for waiver members who have been disenrolled or transferred in or out of managed care service areas and are facing service gaps.

This may involve coordination with MCOs. (10%)

Assist denied Medicaid waiver members in filing fair hearing requests with the state. Monitor and track the fair hearing processes until a decision is reached. (5%)

Undertake additional responsibilities such as generating reports for monitoring program operations, researching and rectifying enrollment errors, and referring members who lose Supplemental Security Income (SSI) eligibility to MEPD.

(10%)

Required Knowledge, Skills, and Abilities:

PREFERRED KNOWLEDGE OF:

  • Medicaid waiver programs, policies, procedures, and eligibility criteria.
  • Community and governmental service delivery frameworks.
  • STAR+PLUS Home and Community Based Services program, Medically Dependent Children Program (MDCP), 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 under demanding conditions.
  • Organizing workload 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, 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 avert them.
  • Establish priorities 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 duties with minimal oversight.
  • Understand new or modified information and effectively communicate that information to others.

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