Remote Community Care Specialist III

FALL CREEK FARM & NURSERY; Tyler (TX); Hybrid; USD 33,000 - 49,000; Full time

Benefits offered by this job

Health insurance

Pension plan

Paid time off

Job summary

Health & Human Services Commission (HHSC) in Tyler, TX seeks a dedicated Community Care Worker III to support Medicaid LTSS waivers and enrollment. The role involves coordinating waiver programs, validating eligibility, and assisting members transitioning from nursing facilities to community-based care.

Telework options are available after training, with full-time, regular hours. Eligible candidates will handle enrollment processes, communicate with MCOs and ME PD staff, and manage case actions

Qualifications

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

Responsibilities

• 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.
• Assist denied Medicaid waiver members to file a fair hearing with the state. Track and monitor the fair hearing processes through to the decision.

Job description

Health & Human Services Commission (HHSC) in Tyler, TX seeks a dedicated Community Care Worker III to support Medicaid LTSS waivers and enrollment. The role involves coordinating waiver programs, validating eligibility, and assisting members transitioning from nursing facilities to community-based care.

Telework options are available after training, with full-time, regular hours. Eligible candidates will handle enrollment processes, communicate with MCOs and ME PD staff, and manage case actions