Community Care Worker III

Texas A&M International; Houston (TX); À distance; USD 33 000 - 49 000; Plein temps

Résumé du poste

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.

Responsabilités

• 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.

Connaissances

Communicating effectively

Managing stress

Multi-tasking

Customer service

Outlook

Word

Excel

TIERS

SASO

LTCOP

Outils

Outlook

Word

Excel

TIERS

SASO

LTCOP

Description du poste

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Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage .

Functional Title: Community Care Worker III
Job Title: Community Care Worker III (CT)
Agency: Health & Human Services Comm
Department: MC Prog Supp & Int Mgmt - Reg
Posting Number: 22671
Closing Date: 11/09/2026
Posting Audience: Internal and External
Occupational Category: Community and Social Services
Salary Range: $2,953.25-$4,365.66
Pay Frequency: Monthly
Salary Group: TEXAS-B-13
Shift: Day
Additional Shift: Days (First)
Telework: Eligible for Telework
Travel: Up to 10%
Regular/Temporary: Regular
Full Time/Part Time: Full time
FLSA Exempt/Non-Exempt: Nonexempt
Facility Location:
Job Location City: HOUSTON
Job Location Address: 5425 POLK ST
Other Locations:
MOS Codes: 42SX,4C0X1

Managed Care Long Term Services and Supports STAR+PLUS Program Support Unit - Community Care Worker III
Travel: 10% for training, meetings

Brief Job Description:

Program Enrollment and Support (PES) under the Medicaid CHIP Services Division (MCS) is searching for new team members to join our Program Support Unit (PSU). PSU is responsible for facilitating the STAR Kids Medically Dependent Children Program (MDCP) and STAR+PLUS Home and Community Based Services (HCBS) eligibility and enrollment process for applicants and members. Services under these programs assist managed care members with maintaining their independence in the community.
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 and staff from external organizations such as Managed Care Organizations (MCOs), 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 program operational policies, procedures, and 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.

Essential Job Functions:

• Attends 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 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. This could include coordinating with MCO’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 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. (10%)

Knowledge, Skills and Abilities (KSA):

Prefer knowledge of:

• Medicaid waiver programs, policies, procedures, and eligibility processes.
• Community and government service delivery systems.
• STAR+PLUS Home and Community Based Services (HCBS) program, Medically Dependent Children Program (MDCP), Intellectual or Developmental Disabilities (IDD) - Long-term Care programs and services.
• Various types of computer equipment and software including, Outlook, Word, and Excel.
• State software such as Texas Integrated Eligibility Redesign System (TIERS), Service Authorization System Online (SASO) or the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP).

Prefer skills in:

• 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.

Prefer the ability to:

• 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., Texas Integrated Eligibility Redesign System (TIERS), Service Authorization System Online (SASO) and Community Services Interest Lists (CSIL).
• Identify potential problems and act proactively to prevent the problem