Care Specialist III

2 months ago

Harlingen, Texas, United States Texas Department of Aging & Disability Services Full time
Job Summary:

We are seeking a highly skilled Community Care Worker III to join our team at the Texas Department of Aging & Disability Services. As a specialist in the Program Support Unit (PSU), you will play a critical role in managing long-term services and supports for individuals enrolled in Medicaid waiver programs.

Key Responsibilities:
  • Develop and coordinate Medicaid waiver programs to meet the needs of applicants and members.
  • Authorize or deny waiver services, ensuring timely and accurate communication with applicants, members, and key stakeholders.
  • Validate eligibility in relevant systems and register waiver program eligibility as needed.
  • Coordinate with Medicaid for the Elderly and People with Disabilities (MEPD) staff for enrollment in Medicaid waiver programs.
  • Perform interest list activities, including confirming contact information, mailing enrollment packets, and ensuring individuals' wishes are assessed for Medicaid waiver programs.
  • Interpret policy and coordinate activities related to transitioning individuals from nursing facilities to the community, handling the transition of children aging out of MDCP services, and people who transition in and out of Medicaid waiver programs.
  • As needed, contact relevant parties to assist with resolution of obstacles and document the reason for delays.
  • Handle continuum of care issues related to long-term services and supports for Medicaid waiver members who have been disenrolled or transferred in or out of managed care service areas and are experiencing a gap in services.
  • Assist Medicaid waiver members who have been denied services to file a fair hearing with the state, tracking and monitoring appeal processes through to the decision.
  • Complete reports to monitor program operations, research and resolve errors in enrollment, and make referrals to MEPD for members who lose Supplemental Security Income (SSI) eligibility.
Requirements:
  • Knowledge of Medicaid waiver programs, policies, and procedures.
  • General knowledge of community and government service delivery systems, case guidelines, regulations, and policies, interviewing techniques, mental illness, and the emotional components of physical illness, individuals' needs associated with disabilities, and community welfare resources.
  • Ability to communicate effectively orally and in writing with all types of people, in all types of situations.
  • Ability to 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.
  • Ability to manage stress in high-profile situations while maintaining a professional demeanor.
  • Ability to identify systemic problems and ways to resolve same.
  • Ability to multi-task under pressure and manage workload effectively to meet goals and objectives of Medicaid waiver programs and meet timeframes.
Working Conditions:

This position requires frequent contact with case managers, individuals enrolled in or applying for Medicaid waiver services, service providers, LTSS MCOs, relocation specialists, nursing facility staff, the public, Health and Human Services Commission, Managed Care Compliance and Operations, Health Plan Management, and Medicaid for the Elderly and People with Disabilities (MEPD) staff.

Work involves operating a computer and requires an extensive knowledge of CCSE/PSU programs and software.

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