Program Specialist IV

About the Role

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our 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.

Responsibilities

• Reviews Level of Need requests tied to provider reimbursement for the Home and Community-based Services (HCS), Texas Home Living (TxHmL) programs, and Intermediate Care Facilities for persons with Intellectual or Developmental Disabilities (ICF/IID). (40%)
• Consults with public and private agencies involved with HCS, TxHmL, and ICF/IID to resolve problems, identify training needs, and discuss outcomes of Level of Need reviews. (20%)
• Ensures compliance with program policies and procedures, statutes, and rules; takes corrective action(s) as needed. (10%)
• Provides feedback and guidance to program staff regarding challenging reviews and cases, including technical assistance to internal staff, external stakeholders, and families on the LON process, submission standards, and rules and regulations. (10%)
• Serves as a Subject Matter Expert and attends meetings with other program areas tied to LON review outcomes and provider reimbursement rates. (5%)
• Assists with responses to legislative, ombudsman, and other external inquiries or complaints, tracks trends, and develops/revises program manual content. (5%)
• Attends work on a regular and predictable schedule and performs other duties as assigned. (5%)
• Works collaboratively across MCS to identify innovative and effective solutions for clients and staff. (5%)

Qualifications

• Graduation from an accredited four-year college or university with a degree in human services or a related field.
• Minimum of one year of experience with persons with intellectual/developmental disabilities or related conditions (to meet QIDP requirements).
• Qualification as a Qualified Intellectual Disability Professional (QIDP) as defined in 42 Code of Federal Regulations 483.430(a) required.

Skills

• Knowledge of utilization review and/or HCS, TxHmL, CLASS, DBMD, and ICF/ID program rules, service array, billing guidelines, local authority functions, and waiver service system.
• Awareness of federal and state laws relating to long-term care and other Medicaid and non-Medicaid services and programs.
• Skill or experience with public speaking or testifying in hearings.
• Ability to communicate effectively, both orally and in writing.
• Ability to multi-task, handle stress, and meet deadlines.
• Proficiency in operating computers and using Microsoft Office products.

Preferred Experience

• At least one year of experience in utilization review or with HCS, TxHmL, CLASS, DBMD, or ICF/ID program rules, service array, billing guidelines, local authority functions, or the waiver service system.

Additional Information

Location: LUBBOCK, TX (with potential for telework)
Salary Range: $4,263.16 - $6,779.25 (Monthly)
Travel: Up to 5%