Care Worker Specialist

19 hours ago

Corpus Christi, 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 perform moderately complex tasks related to managed care Long Term Services and Supports (LTSS).

Key Responsibilities:
  • Develop, coordinate, and explain Medicaid waiver programs to applicants and members.
  • Authorize or deny waiver services, by sending approval or denial notices to applicants, members, and other key parties.
  • Validate eligibility in appropriate systems and register waiver program eligibility in relevant systems.
  • Coordinate with Medicaid for the Elderly and People with Disabilities (MEPD) staff for enrollment in a Medicaid Waiver program.
  • Perform interest list activities, such as confirming contact information, mailing enrollment packets, and determining which Managed Care Organization (MCO) individuals want to enroll with.
  • Interpret policy and coordinate activities related to transitioning individuals from the nursing home to the community, handling the transition of children aging out of MDCP services, and people who transition in and out of a Medicaid Waiver program.
  • Handle continuum of care issues related to LTSS 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 and track and monitor appeal processes through to the decision.
Requirements:
  • Knowledge of Medicaid waiver programs, policies, and procedures.
  • General knowledge of community and government service delivery systems, case guidelines, regulations, and policies.
  • 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, and various state software programs.
  • Ability to manage stress in high-profile situations while maintaining a professional demeanor.
Working Conditions:

This position requires frequent contact with case managers, individuals enrolled in or applying for 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 MEPD staff.

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

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