Program Specialist Iv Jobs

The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of a Program Specialist IV. MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution to MCS's mission by providing highly complex consultative and technical assistance, including research, assessment, and planning directly to management, HHSC program staff, HHSC contract management staff, local authority (LA) staff, the Home and Community-Based Services (HCS), Texas Home Living (TxHmL), Community Living Assistance and Support Services (CLASS), Deaf Blind with Multiple Disabilities (DBMD), and Intermediate Care Facility (ICF/ID) provider base, advocacy groups, stakeholders, program participants, and their families.

The ideal candidate thrives in an environment that emphasizes teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy.

This position reports to the Program Supervisor for Utilization Review for the CLASS and DBMD programs within IDD Waivers, Community Services, and Hospice Utilization Review, and Medicaid and CHIP Services.

Work involves oversight and monitoring of provider requirements for Individual Plans of Care (IPC) and Level of Care/Level of Need (LOC/LON) determinations; routinely reviews and analyzes Intellectual Disability/Related Condition (ID/RC) data to assess the need for additional oversight; conducts desk reviews to determine compliance with HHSC rules, policies, and procedures related to enrollments, IPCs, and LOC/LONs; conducts utilization review and evaluation of proposed IPCs and makes clinical authorization decisions regarding participant eligibility and plans of care; evaluates IPC and eligibility activities and trends to resolve technical problems, identify opportunities for improvement, and make recommendations for improvements in utilization review processes; conducts analysis of data and reports as assigned, and collects, organizes, analyzes, and prepares materials in response to requests for program information or special project reports; develops and revises utilization review tools (e.g., review protocols, evaluation forms, etc.) in accordance with program objectives and goals; will service as the lead to prioritize the work of colleagues by assigning provider deliverables to designated unit staff in absence of the unit supervisor; serves as agency representative in Medicaid fair hearings; conducts training and provides guidance to staff in the development or integration of new or revised operational procedures; coordinates the review and evaluation of information on service delivery system methods, outputs, and activities in order to identify gaps in resources and recommend improvements; coordinates and collaborates with program staff through participation in unit and cross-agency workgroups related to unit functions and planning to analyze, develop, and implement program initiatives; works under limited supervision with considerable latitude for the use of initiative and independent judgement.

Essential Job Functions:
Works collaboratively across MCS to identify innovative and effective solutions for clients and staff, attends work on a regular and predictable schedule in accordance with agency leave policy, and performs other duties as assigned.

Provides highly complex consultative and technical assistance, including research, assessment, and planning directly to management, HHSC program staff, HHSC contract management staff, local authority (LA) staff, the program provider base, advocacy groups, stakeholders, program participants, and their families (20%).

Oversees and monitors provider requirements with Individual Plans of Care (IPC) and Level of Care/Level of Need (LOC/LON) determinations (30%).

Conducts analysis of data and reports as assigned, and collects, organizes, analyzes, and prepares materials in response to requests for program information or special project reports (15%).

Serves as agency representative in Medicaid fair hearings (5%).

Develops and revises utilization review tools (e.g., review protocols, evaluation forms, etc.) in accordance with program objectives and goals (5%).

Conducts training and provides guidance to staff in the development or integration of new or revised operational procedures (10%).

Coordinates and collaborates with program staff through participation in unit, agency, and cross-agency workgroups related to unit functions and planning to analyze, develop, and implement program initiatives (10%).

Will serve as the lead to prioritize the work of colleagues b assigning provider deliverables to designated unit staff during the absence of the supervisor (5%).

Knowledge Skills Abilities:
Ability to work collaboratively across MCS to accomplish objectives; a keen attention to detail and the ability to implement creative solutions to problems; ability to balance team and individual responsibilities.

Graduation from an accredited four-year college or university with a degree in human services or a related field with a minimum of one year of experience with individuals with intellectual/developmental disabilities or related conditions required. At least two years of experience working with individuals with intellectual/developmental disabilities or related conditions preferred.

Knowledge of ID and other developmental disability related conditions, HCS, TxHmL, CLASS, DBMD, and ICF/ID program rules, service array, and billing guidelines, local authority functions, and waiver service system; awareness of federal and state laws relating to long term care and other Medicaid and non-Medicaid services and programs; knowledge of program planning, implementation, and evaluation, and continuous quality improvement.

Skill in the development and maintenance of interpersonal relationships and public speaking; ability to communicate effectively both orally and in writing; ability to interpret statistical information; ability to gather, assemble, correlate, and analyze information to devise solutions to problems; ability to prepare reports; ability to develop, evaluate, and interpret policies and procedures; ability to train, lead, and/or prioritize the work of others; ability to multi-task, handle stress, and meet deadlines.

Ability to operate computers and experience using Microsoft Office products.

Registration or Licensure Requirements:
Qualification as a Qualified Intellectual Disability Professional (QIDP), as defined in 42 Code of Federal Regulations 483.430(a), is required.

Initial Selection Criteria:
Qualification as a Qualified Intellectual Disability Professional (QIDP), as defined in 42 Code of Federal Regulations 483.430(a), is required.

At least two years of experience working with individuals with intellectual/developmental disabilities or related conditions preferred.

Prior experience working in Texas waiver service system highly desirable.

Additional Information:

MOS Code:
Information on the application must clearly state how the applicant meets the initial selection criteria in the Summary of Experience section.

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In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.