Community Care Navigator (Remote Eligible)

Texas A&M International; Houston (TX); Remote; USD 33,000 - 49,000; Full time

Job summary

Texas Health and Human Services Commission in Houston is seeking a Community Care Worker III to support Medicaid waiver programs within the STAR+PLUS and MDCP portfolios. The role involves enrollment, eligibility validation, and coordination with MEPD and MCOs to ensure community-based services for members.

Responsibilities include processing eligibility, handling waivers, and facilitating transitions from pediatric to adult programs, with a strong emphasis on accurate enrollment records and

Qualifications

• Medicaid waiver programs, policies, procedures, and eligibility processes.
• STAR+PLUS HCBS, MDCP, IDD LT Care programs and services.
• Outlook, Excel, Word proficiency.
• TIERS, SASO, LTCOP knowledge.
• Effective communication both verbally and in writing.
• Ability to manage a workload to meet goals and timeframes.

Responsibilities

• Attend work on a regular and predictable schedule.
• Develop, coordinate, and explain waiver programs to applicants and members; authorize services.
• Process waiver eligibility in authorization systems and enroll MCOs.
• Coordinate with MEPD staff for enrollment in Medicaid.
• Assist denied waiver members to file a fair hearing and track it.
• Handle age-out transitions from children’s programs to adult waivers.
• Research and resolve enrollment errors and monitor program operations.

Skills

Communicating effectively

Managing stress

Multi-tasking

Customer service

Outlook

Word

Excel

TIERS

SASO

LTCOP

Tools

Outlook

Word

Excel

TIERS

SASO

LTCOP

Job description

Texas Health and Human Services Commission in Houston is seeking a Community Care Worker III to support Medicaid waiver programs within the STAR+PLUS and MDCP portfolios. The role involves enrollment, eligibility validation, and coordination with MEPD and MCOs to ensure community-based services for members.

Responsibilities include processing eligibility, handling waivers, and facilitating transitions from pediatric to adult programs, with a strong emphasis on accurate enrollment records and