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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 in accessing transformative services that empower them to sustain their independence within the community.

Our roles come with a comprehensive benefits package and flexible telework options 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 role involves regular communication with the public, members, their families, external case managers from Managed Care Organizations (MCOs), service providers, and nursing facility staff.

Additionally, PSU staff will collaborate with various internal departments such as 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 program software.

Responsibilities include guiding 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 member transfers between waiver programs, and coordinating the aging-out process for individuals entering adult Medicaid programs.

This position 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 moderate discretion for initiative and independent judgment.

This role will conduct all activities from a designated office or home office. Case management tasks are not performed through home visits.

Key Responsibilities:

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

Coordinates and clarifies STAR Kids and MDCP waiver services, authorizing services, including approval and denial of waiver services, dispatching approval/denial notifications to applicants, members, and other stakeholders, validating eligibility in TIERS and the Long-term Care Portal, and authorizing MCOs to initiate services.

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

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

If timelines are not adhered to by key stakeholders, contacts the relevant parties 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 accuracy 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 and tracks the appeal process through resolution.

Handles tasks such as compiling reports, investigating and rectifying enrollment errors, or referring individuals who lose Supplemental Security Income (SSI) eligibility to DADS services.

Required Knowledge, Skills, and Abilities:

DESIRABLE 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 such as TIERS, SAS, or LTCOP.

DESIRABLE SKILLS IN:

  • Effective oral and written communication.
  • Managing stress in high-pressure situations while maintaining professionalism.
  • Identifying systemic issues and developing resolutions.
  • Multi-tasking effectively under pressure.
  • Managing workloads to achieve goals and deadlines.
  • Providing excellent customer service.

DESIRABLE ABILITIES TO:

  • Convey instructions and explanations to individuals and key stakeholders, negotiate available services, and provide training to others.
  • Operate computer systems proficiently and understand various state software programs.
  • Identify potential issues and take proactive measures to mitigate 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.
  • Create reports based on research and analysis.
  • Perform duties with minimal oversight.
  • Understand and communicate new or modified information effectively.