Program Specialist V Performs advanced, consultative work requiring specialized knowledge in the planning, development, and implementation of Health and Human Services Commission (HHSC) Medicaid Case Management for Children and Pregnant Women, Personal Care Services (PCS), and Community First Choice (CFC) programs. Collaborates with and provides technical assistance to Department of State Health Services (DSHS) Regional Specialized Health and Social Services (SHSS) case management and liaison staff. Provides senior-level consultative and technical assistance to HHS program staff, other governmental agencies, agency contractors, private Medicaid case management and PCS providers, and community organizations and coalitions. Provides policy development and oversight to Medicaid providers and DSHS regional staff. Requires in-depth knowledge of such programs and/or benefits as: Medicaid; Case Management for Children and Pregnant Women; PCS; Early Periodic Screening, Diagnosis, and Treatment/Texas Health Steps; Supplemental Security Income; Department of Family and Protective Services programs; and other HHS System programs. Works under limited supervision of the Manager, HHSC Case Management, with considerable latitude for the use of initiative and independent judgment.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. This position is a part-time teleworking position with the position’s primary headquarters alternating with the employee’s residence up to two days per week. A minimum six-month period working in the primary headquarters is required for in-office training before teleworking is considered by the manager. (20%) Provides policy development and oversight for case management providers and DSHS regional staff. Develops and updates policy and procedure manuals and related form for Case Management for Children and Pregnant Women and Personal Care Services/Community First Choice in accordance with program objectives and goals. Provides technical assistance to providers and DSHS regional managers on policy implementation and clarification. Reviews and updates, as needed, rules, the Texas Medicaid Provider Procedure Manual and Medicaid Medical Policies for accuracy and completeness. Communicates program changes through the Medicaid Bulletin process as appropriate. Analyzes legislation to develop recommendations for policy and programmatic issues relating to the implementation, improvement, and program funding. (20%) Develops and implements effective techniques for evaluating agency programs. Provides guidance and consultative services to providers and DSHS regional staff in the development and integration of new methods and procedures, and to plan and monitor the effectiveness of agency programs. Develops systems for and implements utilization review and quality assurance oversight activities. Oversees and/or conducts surveys, inspections, or reviews to determine compliance with rule requirements, laws, regulations, and policies and procedures. Develops and reviews evaluation tools. Monitors reporting of all technical assistance performed and reported by DSHS regional staff. Oversees analysis of operations, addresses problem areas, conducts studies, and prepares detailed and comprehensive administrative reports on data analysis and interpretation, findings, and recommendations. Collects, organizes, analyzes, and prepares material in response to requests for information and reports. (15%) Ensures client eligibility by establishing service criteria. Approves/denies prior authorizations or gives guidance in the authorization of the level of service for programs. Problem solves billing issues with case management providers using the Phoenix system and with PCS/CFC case managers through Medicaid leadership or contractors. Ensures provider eligibility by establishing provider criteria, and reviewing and approving provider applications for Case Management for Children and Pregnant Women program. Liaisons with the Medicaid claims administrator to ensure provider enrollment. (15%) Investigates and resolves complaints from and communicates outcomes to DSHS regional staff, Medicaid providers, clients and families, Medicaid leadership, Office of Ombudsman, and community members. Examines trends and establishes corrective measures as appropriate. Liaisons with appropriate investigatory agencies. (15%) Engages with community and professional groups to coordinate, improve, and promote programs. Speaks to participants in statewide professional conferences for the purpose of program education, outreach, and provider recruitment. Serves as a liaison with various programs/units in HHSC, DSHS Regional SHSS, Department of Family and Protective Services, state and national organizations, and professional licensing boards related to programs. Coordinates services Texas Health Steps, and other HHS system programs. (10%) Plans, organizes, and implements training/ongoing education for providers and DSHS regional staff in accordance with program objectives and goals. Provides technical assistance to DSHS regional staff to assist in planning/developing educational programs on case management and PCS/CFC. Develops and updates training manuals. ( 5%) Conducts special projects, initiatives, directives, or duties as assigned in support of HHSC division, department, unit, or section.
Knowledge Skills Abilities:
Knowledge of local, state, federal laws, and legal mandates relating to the program areas of Medicaid, EPDST/Texas Health Steps, managed care, and case management. Skill in the provision of case management services, including assessment of family needs, exploring resources, advocacy, and development of service plans. Skill in developing training manuals and presenting training/educational programs. Skill in the use of personal computers, software, and client databases, including Microsoft Word, Excel, Windows Explorer, Outlook, and Internet Explorer. Skill in program planning, evaluation, and data analysis. Ability to develop, interpret, and evaluate policies and procedures. Ability to work independently to gather and analyze information and to devise solutions to problems. Ability to provide technical assistance. Ability to organize and prioritize workload and to meet deadlines. Ability to coordinate complex projects among different staff members or agencies. Ability to communicate effectively, both verbally and in writing. Ability to establish and maintain effective working relationships.
Registration or Licensure Requirements:
Safe operation of either a state-owned vehicle or personal vehicle is required to conduct state business and an acceptable driving record must be maintained in accordance with DSHS Policy OS-3901, Fleet Operations and Management & Procedures and standards developed by the Texas Department of Public Safety. Current license to practice social work, including LBSW, LMSW, and LCSW licensure or current license to practice as a registered nurse in the State of Texas.
Initial Selection Criteria:
Current license to practice social work or current license to practice as a Registered Nurse in the State of Texas. Experience developing policy and administrative procedures, providing technical assistance, and training development and implementation. Experience in policy development, program planning, evaluation, reporting, and data analysis. Experience working with governmental agencies and programs, including case management programs.
There may be no military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position. All active duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information, see the Texas State Auditor’s Military Crosswalk at ****Compensation/JobDescriptions.aspx. There will be a skills assessment exercise. req#372638
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