- Medicaid waiver programs, policies, procedures and eligibility processes.
- Community and government service delivery systems.
- STAR+PLUS Home and Community Based Services program, Medically Dependent Children Program (MDCP), IDD programs services.
- Various types of computer equipment and software including, Outlook, Word, and Excel.
- State software such as TIERS, SAS or the LTCOP.
- 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.
- 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., TIERS, SAS and 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.
- 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.
- Preferred knowledge of managed care programs, LTSS Programs and Medicaid Waiver programs.
- Effective written and oral communications skills.
- Demonstrated ability to manage workloads effectively to meet goals, objectives and meet deadlines.
- Preferred experience using computer equipment and Microsoft software.
- Preferred experience and/or training that relates to job duties.
-
Workers' Compensation Claims Adjuster III
3 weeks ago
AmTrust Financial Dallas, United States Regular Full timeOverview · Assigned to our Worker's Compensation Line of Business, the Adjuster III is responsible for prompt and independent review of insurance claims through effective research, evaluation, investigation, negotiation and interaction with insureds or claimants. The Adjuster II ...
-
Workers' Compensation Claims Adjuster III
6 days ago
AmTrust Financial Dallas, United States· Workers' Compensation Claims Adjuster III · Job Locations · US-TX-Dallas · Requisition ID · Category · Claims - Workers Compensation · Position Type · Regular Full-Time · Overview · Assigned to our Worker's Compensation Line of Business, the Adjuster III is responsible for pro ...
-
Medical Management Social Worker III
2 weeks ago
Health Care Service Corporation Richardson, United StatesAt HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career. · Come join us and be part of a purpo ...
-
30266 General Maintenance Worker III
2 weeks ago
Garland Independent School District Garland, United StatesPosition Type: · Maintenance/CUSTODIAL · Date Posted: · 2/9/2024 · Location: · Padgett Auxiliary Services Center · Duty Days: 260 · Pay Grade: MT07 Min: $22.27 Mid: $26.26 Hourly rates · Technology Literacy: E-mail · Application Questions: · Deadline: Until Filled · Interview ...
-
Registered Nurse
1 week ago
Department of Veterans Affairs Grand Prairie, United StatesRegistered Nurse - Only for Current Permanent Employees of North Texas Health Care System · Summary · This Open Continuous Announcement (OCA) is open only to current, permanent employees of the North Texas VA Health Care System. Applications will expire after 90 days. Employees u ...
-
Drafter III
1 week ago
Wilks Brothers Irving, United States Full timePosition Summary · : The Drafter III will work directly with designers, engineers, manufacturing and service to produce a detailed drawing set for custom components. Prepare detailed working drawings of machinery and mechanical devices that include dimensions, fastening methods ...
-
Supplementary staff in Oberpleis
3 weeks ago
FusionWorks Everman, United StatesThe Protestant Kindergarten Oberpleis · is looking for · a supplementary staff member (m/f/d) · (39 hours per week, permanent position) · Our single-group kindergarten provides care for 25 children aged three to school entry in group form III according to KiBiz NRW. The pedagogi ...
-
RRT/CRT Full-time
1 week ago
Infojini Healthcare Arlington, TX, United States Full timeID: Shift: 18:00-06:00 Description: · City Arlington3301 Matlock RdArlington, TX 76015Telephone: About Medical City ArlingtonWe would like to take this opportunity to introduce you to Medical City Arlington. Originally opened in August 1976 as Arlington Community Hospital in a r ...
-
Mechanic I-III 1208/24/20
1 week ago
City of Euless, TX Euless, United StatesJOB SUMMARY: · Mechanic I: Under direct supervision, performs preventive maintenance on city equipment, and performs various road service calls, assists on minor repairs, and performs basic shop maintenance. · Mechanic II: Under general supervision, performs major repairs on ligh ...
-
Claims Specialist
5 days ago
CorVel Corporation Dallas, United States Full timeCorVel in Dallas, TX is seeking a Claims Specialist for their Indemnity department. We are looking for experience handling Workers Compensation Indemnity claims in Texas, Oklahoma and Arkansas and a willingness to learn or have experience in additional states including Louisiana, ...
-
Locum Physician
2 weeks ago
LocumJobsOnline Dallas, United States Full timeLocumJobsOnline is working with Adelphi Medical Staffing to find a qualified Pulmonology MD in Longview, Texas, 75605 · About The Position · Job Quick Facts: · • Specialty: Pulmonology - Critical Care · • Job Type: Locum Tenens · • Facility Location: Longview, TX · • Service Sett ...
-
Construction Inspector V- CEI
2 weeks ago
Raba Kistner Dallas, United States Full timeRaba Kistner, Inc. is a premier Engineering Consulting and Program Management firm. Our purpose is to build a better and more sustainable world for our employees, their families, our clients, and the communities we serve. Our Core Values are:Community "We care for our communities ...
-
Locum Physician
2 weeks ago
LocumJobsOnline Dallas, United States Full timeLocumJobsOnline is working with Adelphi Medical Staffing to find a qualified Cardiovascular Disease MD in Longview, Texas, 75605 · About The Position · Job Quick Facts: · • Specialty: Cardiovascular Surgery · • Job Type: Locum Tenens · • Facility Location: Longview, TX · • Servic ...
-
Locum Physician
2 weeks ago
LocumJobsOnline Dallas, United States Full timeLocumJobsOnline is working with Adelphi Medical Staffing to find a qualified Cardiovascular Disease MD in Longview, Texas, 75605 · About The Position · Job Quick Facts · • Specialty: Cardiovascular/Cardiothoracic Surgery · • Job Type: Locum Tenens · • Location: Longview, TX · • S ...
-
Clinical Staff Pharmacist, Transitions of Care
2 weeks ago
UT Southwestern Dallas, United States Full timeWhy UT Southwestern? · Join UT Southwestern on our mission to educate, discover and heal. With over 75 years of excellence in Dallas-Fort Worth, Texas, we are committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we stri ...
-
Business Analyst 2
1 week ago
Abacus Service Corporation Dallas, United States ContractSolicitation Reference Number · Customer Name · Texas Health and Human Services Commission · Category · Applications/Software Development · Customer Entity Name · Health and Human Services Commission · Title · Business Analyst · Level · Business Analyst · Estimated Hours · Numb ...
-
Advanced Pharmacy Technician, Infusion Services
3 weeks ago
UT Southwestern Dallas, United States Full timeAdvanced Pharmacy Technician, Infusion Services · Why UT Southwestern? · With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. At UT Southwestern, we invest in you with opportunities for ...
-
Security Monitor III, Community Corrections
3 weeks ago
CoreCivic Fort Worth, United States$18.09 per hour · AtCoreCivic, our employees are driven by a deep sense of service, high standards ofprofessionalism and a responsibility to better the public good. We are currently seeking a Security Monitor III, Community Corrections who has apassion for providing the highest ...
-
Claims Specialist
1 week ago
CorVel Corporation Fort Worth, United States Full timeThe Auto/PD Liability Claims Specialist manages within company best practices complex and non-complex Auto and General Liability claims. Additionally, the Specialist will work within delegated authority to best possible outcomes for CorVel and our clients. · This is a remote posi ...
-
Social Worker, LMSW
3 days ago
Texas Health Resources Bedford, United StatesSocial Worker / Care Transition Manager / PRN (As Needed) · Position Highlights · Location: Texas Health HEB 1600 Hospital Parkway TX 76022 · Environment: Care Transition Management · Hours: PRN (As Needed) · Texas Health HEB is a 252-bed, acute-care, full-service hospital servin ...
Community Care Worker III - Grand Prairie, United States - Texas Health & Human Services Commission
Description
Community Care Worker III (CT)Program Enrollment and Support (PES) is searching for new team members to join our Program Support Unit (PSU).
PSU is responsible for working with our managed care members to enroll them in life changing services to maintain their independence in the community.
Our positions offer an excellent benefits package and telework options after successfully completing initial training.PSU staff perform moderately complex tasks related to Medicaid managed care Long Term Services and Supports (LTSS).
Work involves frequent telephone contact with the general public, members and their families, case managers from external organizations such as Managed Care Organizations (MCOs), service providers and nursing facility staff.
PSU staff will also coordinate with various internal HHSC departments such as Managed Care Compliance and Operations (MCCO) and Medicaid for the Elderly and People with Disabilities (MEPD).
Upon successful completion of training, PSU staff will have full knowledge of PSU operations and program software.Duties include assisting applicants with the eligibility and enrollment processes for Medicaid waiver programs, approve and deny eligibility for Medicaid waiver programs, provide assistance to members transitioning from a nursing facility to the community, validate and enter waiver eligibility records in authorization systems, notify members of Medicaid waiver program eligibility, manage 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.
This position requires extensive computer usage, research and comprehension of program policies and procedures to successfully process cases according to PSU program policy and procedures.
Staff work under general supervision with moderate latitude for the use of initiative and independent judgment.This position will conduct all work activities from an HHSC or home office. Case management activities are not conducted via home visits.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
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. (10%)
Research and trouble-shoot case actions and document delay reasons. (5%)
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.
Assist denied Medicaid waiver members to file a fair hearing with the state. Track and monitor the fair hearing processes through to the decision. (5%)
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.
Knowledge Skills Abilities:
PREFER THE KNOWLEDGE OF:
PREFER SKILLS IN:
PREFER THE ABILITY TO:
Registration or Licensure Requirements:
NONE Initial Selection Criteria:
Additional Information:
Additional Information:
Telework opportunities are available in accordance with business needs.
Only applications with the job experience completed on the application will be considered.
SALARY NOTE:
The posted salary range reflects the minimum and maximum allowable by state law. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC.
Note:
Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include: 4COX1.
For more information, see the Texas State Auditor's Military Crosswalk atHHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work. I-9 Form - Click here to download the I-9 Form.
In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability.
If you need assistance completing the online application, contact the HHS Employee Service Center at If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.
MOS Code:
Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include: 4COX1.
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.
I-9 Form - Click here to download the I-9 form.
In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability.
If you need assistance completing the on-line application, contact the HHS Employee Service Center at If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.
Top 10 Tips for Success when Applying to Jobs at HHSC and DSHS
Community Care Worker III professionals in Grand Prairie
-
guillermo aiken
Fitness Coach
-
Celine Le
Interior Design Student