Community Care Advocate III (Remote Eligible)

Texas Health and Human Services; Harlingen (TX); On-site; USD 33,000 - 49,000; Full time

Benefits offered by this job

Telework eligible

Job summary

Texas Health and Human Services in Harlingen, TX seeks a Community Care Worker III to support Medicaid waiver programs (MDCP, HCBS, STAR+PLUS) and assist applicants and members with eligibility and enrollment. The role involves coordinating with MCOs, MCCO, and ME PD, handling appeals, and maintaining records in TIERS/SASO/LTCOP.

The position requires strong communication, policy interpretation, and time-management skills, with telework opportunities and a daily schedule in a fully on-site

Qualifications

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

Responsibilities

• Attend work on a regular and predictable schedule.
• 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 for enrollment in Medicaid.
• Coordinate with MEPD staff for enrollment in Medicaid; assist members transitioning from nursing facilities to the community.
• Research and troubleshoot case actions and document delay reasons; handle continuity of care issues and referrals to MEPD as needed.
• Assist denied Medicaid waiver members to file a fair hearing and track/process hearings to outcome.
• Prepare reports for monitoring program operations and resolve enrollment errors.

Skills

Oral communication

Written communication

Stress management

Multi-tasking

Time management

Customer service

Education

High School Diploma or GED

Tools

Outlook

Word

Excel

TIERS

SASO

LTCOP

Job description

Texas Health and Human Services in Harlingen, TX seeks a Community Care Worker III to support Medicaid waiver programs (MDCP, HCBS, STAR+PLUS) and assist applicants and members with eligibility and enrollment. The role involves coordinating with MCOs, MCCO, and ME PD, handling appeals, and maintaining records in TIERS/SASO/LTCOP.

The position requires strong communication, policy interpretation, and time-management skills, with telework opportunities and a daily schedule in a fully on-site