Program Specialist IV

Overview Posting ID 18940 – Health & Human Services Commission (HHSC). Program Specialist IV within Medicaid CHIP Services (MCS) provides oversight and monitoring of provider requirements with Individual Plans of Care (IPC) and Level of Care/Level of Need (LOC/LON) determinations. This position supports HHSC program staff, local authorities, waivers units, and various service programs, ensuring compliance, evaluation, and continuous improvement. The role reports to the HCS/TxHmL Program Supervisor in the IDD Waivers Unit of Utilization Review and is full-time with day shift and telework eligibility where applicable. Responsibilities Provide highly complex consultative and technical assistance, including research, assessment, and planning to management, HHSC program staff, contract management staff, local authority staff, program providers, advocacy groups, stakeholders, program participants, and families. Oversee and monitor provider requirements with IPCs and LOC/LON determinations. Conduct analyses of data and reports; prepare materials in response to program information requests or special project reports. Develop and revise utilization review tools (e.g., review protocols, evaluation forms) aligned with program objectives and goals. Serve as agency representative in Medicaid fair hearings and provide guidance to staff on new or revised procedures. Coordinate reviews and evaluations of information on service delivery system methods to identify gaps and recommend improvements. Collaborate with program staff through unit and cross-agency workgroups to analyze, develop, and implement program initiatives. Assist in prioritizing work and, when applicable, lead in the supervisor’s absence; work with the MCS team to identify innovative solutions for clients and staff. Qualifications Registrations, Licensure, or Certifications: Qualification as a Qualified Intellectual Disability Professional (QIDP) as defined in 42 Code of Federal Regulations 483.430(a) is required. Knowledge, Skills & Abilities: Ability to work collaboratively across MCS to accomplish objectives; balance team and individual responsibilities. Knowledge of ID and other developmental disability conditions, HCS, TxHmL, CLASS, DBMD, and ICF/ID program rules, service array and billing guidelines, local authority functions, and waiver service systems. Interpersonal skills, public speaking, and effective written and oral communication. Ability to multi-task, handle stress, meet deadlines; proficient in Microsoft Office. Initial Screening Criteria: QIDP credential as defined in 42 CFR 483.430(a) is required. Additional Details Telework: May be eligible for telework; subject to state and agency policies and supervisor discretion. Travel: Up to 5% travel. Employment Type: Regular, full time; FLSA Exempt/Non-Exempt: Nonexempt. Location: Job location in Austin, TX with listed locations as applicable; facility address: 701 W 51ST ST. Other Information Active duty, military, reservists, guardsmen, and veterans are encouraged to apply if qualified. HHSC uses E-Verify and requires I-9 documentation on first day. ADA accommodations and pre-employment checks may apply per program requirements. #J-18808-Ljbffr