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Job/Position DescriptionCommunity 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 childrenand#146;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 FunctionsAttends 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. This includes activities for members transitioning out of nursing facilities to the community. (50%)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. (10%) Perform age out activities by coordinating activities related to transitioning individuals from a childrenand#146;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. This could include coordinating with MCOand#146;s. (10%) 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 othe https://jobshrportal.hhsc.state.tx.us/ENG/CareerPortal/job_profile.cfm?szOrderID=619387 Copy the URL in the preceding sentence to an Internet Explorer browser to apply to the job directly through the Texas Health and Human Services Career Portal.