Program Specialist IV

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Functional Title: Program Specialist IV

Job Title: Program Specialist IV

Agency: Health & Human Services Comm

Department: MC Contracts and Oversight

Posting Number: 21167

Closing Date: 09/25/2026

Posting Audience: Internal and External

Occupational Category: Community and Social Services

Salary Range: $4,263.16 - $6,779.25

Pay Frequency: Monthly

Salary Group: TEXAS-B-20

Shift: Day

Additional Shift:

Telework:

Travel:

Regular/Temporary: Regular

Full Time/Part Time: Full time

FLSA Exempt/Non-Exempt: Nonexempt

Facility Location:

Job Location City: AUSTIN

Job Location Address: 701 W 51ST ST

Other Locations:

MOS Codes: 16GX,60C0,611X,612X,63G0,641X,712X,86M0,8U000,OS,OSS,PERS,YN,YNS

Brief Job Description:

The HHSC Medicaid CHIP Services (MCS) division seeks a highly qualified candidate to fill the position of the Program Specialist IV in Managed Care Contracts and Oversight (MCCO). MCS is driven by its mission to deliver quality, cost-effective services to Texans. The Program Specialist IV makes a significant contribution to MCS's mission by ensuring managed care organizations are compliant with all state and federal regulations, contractual requirements, established policies, rules and regulations. 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.

The Program Specialist IV is selected by and reports to the Deputy Director within MCCO.This position will be assigned to a team responsible for ensuring compliance with contracts between managed care organizations (MCO) and the agency. This position performs complex (journey-level) analysis and continuous review of the MCO to determine the appropriateness of operations and contract compliance. This position reviews MCO materials and evaluates compliance with contract requirements and manages corrective actions. This position participates in the development, implementation, analysis, and documentation of MCCO policies and processes and makes recommendations for changes as needed. This position works under general direction with some latitude for the use of initiative and independent judgment. This position performs other duties as may be assigned or required and attends work on a regular and predictable schedule.

Essential Job Functions (EJFs):

(30%) Ensures compliance with contract requirements and evaluates MCO compliance by reviewing the contract deliverables for compliance with state and federal regulations. On a prompt and continuous basis accurately finalizes the review of MCO materials (deliverable) in accordance with required timeframes to determine appropriateness by utilizing contracts, manuals, issued guidance and notices, and state and federal rules and regulations. Works collaboratively and follows up promptly with MCCO staff, Medicaid/CHIP program SMEs, and other internal/external stakeholders as needed to ensure the appropriateness of MCO materials (deliverable). Promptly informs the Manager of significant or indication of MCO/DMO compliance issues and provides recommendations for action. Works promptly and collaboratively to recommend remedies for noncompliance of contractual requirements. Responds and provides accurate information to legislative, open records and audit requests within specified timeframes.

(20%) Collaborates actively in the planning, development, implementation, analysis, and documentation of functions related to training, onsites, desk reviews, implementations, readiness reviews, information sessions, special projects and other activities as required and within the specified timeframes. Collaborates in determining trends and resolving technical problems.

(20%) Establishes and maintains effective working relationships and communications with the MCO, HHS staff, and other internal/external stakeholders and provides timely responses to requests and inquiries.Receives no more than 1-2 justified complaints per annual review period from internal or external stakeholders regarding professional conduct, appropriate interactions with others, timely responses and follow up, and/or work and email etiquette.

(10%) Demonstrates commitment to the goals of the Medicaid/CHIP services, shows initiative to take on new projects. Team-oriented and committed to outstanding customer service and focuses on promoting efficiencies and accountability.Communicates with Manager in a timely manner regarding problematic situations and applies independent judgment to ensure action taken is appropriate.

(10%) Participates in the review of RFP and evaluation of RFP responses within assigned timeframes. Participates in the review, analysis, and evaluation of rules, bills, and federal/state laws with implications to the Medicaid/CHIP programs as required.

(10%) Attends work on aregular predictable schedule in accordance with agency leave policy. Performs Other duties as assigned, timely and accurately.

Knowledge, Skills and Abilities (KSAs):

Knowledge of subsidized health insurance, including Medicaid, Medicaid Managed Care, and/or CHIP.

Knowledge of contract management and compliance principles.

Ability to work under limited direction and to use initiative and independent judgment.

Analytical and organizational skills and the ability to conduct investigations or audits;gather, assemble, correlate, and analyze facts and data; and devise solutions to problems.

Knowledge of state and federal laws, regulations and processes regarding Medicaid Managed Care and CHIP. Skill in using personal computer applications software such as Microsoft Word, Excel, Power Point, or other similar programs.

Skill in written and oral communication, including the ability to make public presentations, write technical information in an understandable format, produce sophisticated research and analytical reports. Ability to research and evaluate policies and procedures.

Registrations, Licensure Requirements or Certifications:

N/A

Initial Screening :

Required: Two years of education at an accredited four-year college or university. The educational requirement may be substituted for relevant work experience on a year-for-year basis. Strong written communication skills as demonstrated by submitted application materials.

Preferred: Prior work experience in a field related to Medicare, Medicaid fee-for-service, Medicaid Managed Care, and/or CHIP preferred.

Additional Information :

Certified Texas Contract Manager Certification (CTCM) or must obtain within 12 months upon hire.

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor's Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditors Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS 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.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.