Community Care Worker III

About the role

Program Enrollment and Support (PES) under the Medicaid CHIP Services Division (MCS) is searching for new team members to join our Program Support Unit (PSU).

Responsibilities

• Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
• Develop, coordinate, and explain waiver programs to applicants and members.
• Authorize or deny waiver services, send approval and denial notices.
• Validate eligibility in appropriate systems.
• Register waiver program eligibility in authorization system, authorize MCOs to begin approved services.
• Coordinate with MEPD staff for enrollment in Medicaid.
• Perform interest list activities such as confirming accurate contact information, mail enrollment packets, determine appropriate MCO enrollment and verify applicants desire to enroll in a Medicaid waiver program.
• Perform age out activities by coordinating activities related to transitioning individuals from a children’s program to an adult waiver.
• Research and trouble-shoot case actions and document delay reasons.
• Handle continuum of care issues related to waiver members who have been disenrolled or transferred in or out of managed care service areas and are experiencing a gap in services. This could include coordinating with MCO’s.
• Afford fair hearing requests for program denials, transfer members between waiver programs, and coordinate the age out process for individuals enrolled in a children’s Medicaid program.
• Handle other duties such as reports for monitoring program operations, research and resolve errors in enrollment and make referrals to MEPD for members who lose Supplemental Security Income (SSI) eligibility.

Requirements

• High School Diploma or GED required.
• Prefer experience with case management.
• Prefer experience in a position requiring time management skills.
• Prefer experience with complex policy interpretation requiring good judgement.

Qualifications

Knowledge Of Knowledge, Skills and Abilities (KSAs): Medicaid waiver programs, policies, procedures, and eligibility processes. Community and government service delivery systems. STAR+PLUS Home and Community Based Services (HCBS) program, Medically Dependent Children Program (MDCP), Intellectual or Developmental Disabilities (IDD) - Long-term Care programs and services. Various types of computer equipment and software including, Outlook, Word, and Excel. State software such as Texas Integrated Eligibility Redesign System (TIERS), Service Authorization System Online (SASO) or the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP).

Skills

• Communicating effectively orally and in writing.
• Managing stress in high-profile situations while maintaining a professional demeanor.
• Identifying systemic problems and ways to resolve those problems.
• Multi-tasking under pressure.
• Managing a workload to meet goals, objectives and timeframes.
• Customer service.
• Ability To Convey instructions and explanations to individuals and key parties, to negotiate available services, and to train others.
• 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., Texas Integrated Eligibility Redesign System (TIERS), Service Authorization System Online (SASO) and Community Services Interest Lists (CSIL).
• Identify potential problems and act proactively to prevent the problem.
• Establish priorities according to relative importance and deadlines, set goals and manage time efficiently.
• Interpret complex policy and procedure.
• Gather, assemble, correlate, and analyze facts to devise solutions to problems.
• Develop reports based on research and analysis.
• Perform duties with minimal supervision.
• Understand new or changed information and to effectively relay that information to others.

Benefits

Comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more.