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) division is seeking dedicated individuals to become part of our Program Support Unit (PSU).

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

Our roles come with a comprehensive benefits package and the possibility of remote work 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 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 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 include assisting applicants with the eligibility and enrollment processes for Medicaid waiver programs, making decisions on eligibility for these programs, aiding members in their transition from nursing facilities to community settings, validating and entering waiver eligibility data into authorization systems, informing members about their Medicaid waiver program eligibility, managing fair hearing requests for program denials, facilitating transfers between waiver programs, and overseeing the age-out process for individuals transitioning from 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 a moderate degree of autonomy and independent judgment.

All work activities will be conducted from an HHSC or home office, with case management tasks not requiring home visits.

Key Responsibilities:

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

Develop, coordinate, and clarify waiver programs for applicants and members. Authorize or deny waiver services, and communicate approval and denial notifications. Validate eligibility within relevant 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 settings. (50%)

Conduct interest list activities, including confirming accurate contact details, mailing enrollment packets, determining suitable MCO enrollment, and verifying applicants' interest in Medicaid waiver programs.

(10%)

Manage age-out activities by coordinating transitions for individuals moving from children's programs to adult waivers.

(10%)

Investigate and resolve case actions and document reasons for 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 and monitor the fair hearing process until a decision is reached. (5%)

Perform additional tasks such as generating reports for monitoring program operations, researching and correcting 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 applications 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 developing solutions.
  • Multi-tasking effectively under pressure.
  • Managing workloads to achieve goals and deadlines.
  • Providing excellent customer service.

PREFERRED ABILITY TO:

  • Convey instructions and explanations to individuals and key stakeholders, negotiate available services, and provide training to others.
  • Operate computer systems proficiently and gain a general understanding of various state software programs, such as TIERS, SAS, and CSIL.
  • Identify potential issues and take proactive measures to prevent 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 devise solutions to problems.
  • Generate reports based on research and analysis.
  • Perform tasks with minimal supervision.
  • Comprehend new or modified information and effectively communicate that information to others.

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