Program Specialist IV

Job Description : Posted Statewide

Posted Statewide

Program Specialist IV Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of 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 oversight and monitoring of provider requirements with Individual Plans of Care (IPC) and Level of Care / Level of Need (LOC / LON) determinations.

The Program Specialist IV position completes highly complex consultative and technical assistance, including research, assessment and planning directly to management, HHSC program staff, HHSC contract management staff, local authority (LIDDA) staff, the Home and Community-based Services (HCS), Texas Home Living (TxHmL), Community Living Assistance and Support Services (CLASS), Deaf Blind with Multiple Disability (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 HCS / TxHmL Program Supervisor in the IDD Waivers Unit of Utilization Review to work on the HCS / TxHmL team.

Responsibility for this position includes : 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 to 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.

May serve 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 judgment. Essential Job Functions :

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. (25%)

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. (10%)

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%)

Works collaboratively across MCS to identify innovative and effective solutions for clients and staff. (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.

Able to balance team and individual responsibilities.

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; to prepare reports; to develop, evaluate, and interpret policies and procedures;

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.