CSHCN Eligibility Team Lead

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Employee Benefits:

DSHS offers insurance coverage and other benefits available through the State of Texas Group Benefits Plan administered by the Employee Retirement System of Texas (ERS). To learn more about all the benefits available to you as a DSHS employee and other DSHS opportunities for early career pathways, visit the DSHS Careers Page.

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Functional Title: CSHCN Eligibility Team Lead 
Job Title: Publ Hlth and Prevent Spcl III 
Agency: Dept of State Health Services 
Department: Region 4/5 
Posting Number: 17066 
Closing Date: 06/01/2026 
Posting Audience: Internal and External 
Occupational Category: Community and Social Services 
Salary Range: $3,793.41 - $4,857.33 
Pay Frequency: Monthly
Salary Group: TEXAS-B-18 
Shift: Day 
Additional Shift:  
Telework:  
Travel: Up to 30% 
Regular/Temporary: Regular 
Full Time/Part Time: Full time 
FLSA Exempt/Non-Exempt: Nonexempt 
Facility Location:  
Job Location City: TYLER 
Job Location Address: 2521 W FRONT ST 
Other Locations:  
MOS Codes: 230X,43EX,43HX,4B0X1,4E0X1,60C,68S,68Z,HM,HS,MED,NAP11,SEI12 
 
 
 

Brief Job Description:
Under the supervision of the Regional Manager of Specialized Health/Social Services or designee, participates as a member of the comprehensive social work program (Children with Special Health Care Needs Services Program (CSHCN-SP),  Newborn Screening (NBS), Newborn Hearing Screening (NBHS), Childhood Lead Poisoning Prevention Program (CLPPP), Personal Care Services and Private Duty Nursing (PCS/PDN), and Children’s Health Insurance Program (CHIP). Works under moderate supervision with limited latitude for use of initiative and independent judgment, performs complex public health and human services work, and renders decisions on Children with Special Health Care Needs (CSHCN) Program eligibility for clients in HSR 4/5N. Acts as CSHCN Eligibility Team Lead and is responsible for coordination of all regional CSHCN eligibility procedures and application processing both within the region and with Central Office in Austin. Provides complex reviews of CSHCN applications, including reviews of financial and medical information to determine applicability of CSHCN Program rules. Interprets and complies with CSHCN rules, regulations, policies and procedures relating to CSHCN eligibility. Follows established procedures for CSHCN automated "IBIS" system eligibility processing. Develops, coordinates and maintains up to date records of all applications and outcome determinations processed and collects data, keeping breakdown totals on those received, approved, denied, sent to Austin for appeal and ones processed under specific spenddown procedures. Also maintains program statistics. Assures daily determination information letters are generated and audited, including information for Medicaid/Medically Needy Program and Children's Health Insurance Program (CHIP), which are necessary for the completion of the CSHCN application process. Serves as a public resource and confers on a daily basis with other regional eligibility personnel, social workers, medical staff, and personnel from other agencies to provide technical assistance, policy, interpretation/updates, problem resolution, and follow up on incomplete applications. Maintains regional CSHCN client database, files, documentation, and reports. Works as part of a team with other eligibility staff. Provides orientation and training in the eligibility operations and process to new staff, including updates to all social work staff. Employee actively participates and/or serves in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Maintains confidentiality. Attends to other assignments as directed by Regional Manager of Specialized Health/Social Services or designee. 

Essential Job Functions:
25% Responsible for coordination of all CSHCN eligibility procedure/processing in the Region. Performs complex reviews of applications for determination of program eligibility including evaluating applications and supplemental information for eligibility bases on financial, residency, age and medical criteria; performs complex data entry; interviews applicants and collateral sources as necessary to follow-up incomplete applications.
25% Provides technical assistance to regional social work staff, CSHCN providers and/or potential providers concerning provider enrollment, authorization and claims processing. Assists case managers in the resolution of problems between clients, providers of services, and regional staff. Works directly with providers to obtain authorizations for services and filing claims as needed. Provides interpretation of relevant changes as they occur. May interview and provide guidance and assistance to clients with completion and submission of eligibility applications for Medicaid/Medically Need Program and CHIP, assuring compliance with timelines mandated by the CSHCN Program. Answers or returns all telephone or email inquiries regarding eligibility status by providing prompt and correct information on CSHCN rules and individual cases.
15% Maintains accurate files on all cases: approved, denied and incomplete. Documents case data and enters records of findings and determinations; completes various standard forms. Generates and sends correct eligibility letters to program applicants. Prepares workload reports and other special and routine reports in a timely manner. Maintains related records. Prepares and assembles case records; distributes according to geographic area. Researches and compiles regional statistics related to CSHCN eligibility processing by reviewing various printouts, determination summaries and weekly production reports.
15% Functions as team leader to CSHCN Eligibility Specialist (Human Services Specialist I) in accordance with agency and program policies. Reviews and approves travel. Participates in the Performance Evaluation Process.
10% Works with local health agencies, private physicians, individuals, and community action groups to enhance awareness of prevention of chronic diseases and childhood disabilities. Provides information to potential clients about agency programs and services and distributes published materials outlining eligibility requirements. Serves as an information and referral source to the public regarding appropriate community resources.
5% Provides new social work and clerical staff with orientation and training in the eligibility determination process. 
5% Other duties as assigned – Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location. Other duties as assigned by Manager of Specialized Health/Social Services or designee.

Knowledge, Skills, and Abilities:
Knowledge of social, economic, and public health issues.
Knowledge of working with computer systems and software applications.
Knowledge of medical terminology and medical care specialties.
Knowledge of DSHS and SHSS client services programs and Medicaid covered services.
Knowledge of the Children with Special Health Care Needs program.
Skill in use of computer programs and maintaining information systems.
Skill in organization, prioritizing, planning , problem-solving, attending to details, and meeting deadlines.
Skill in implementation of program policies and procedures.
Skill in coordinating and scheduling.
Skill to function in a culturally competent manner.
Ability to maintain confidentiality.
Ability to select and evaluate relevant facts from case records and application forms in relation to eligibility criteria.
Ability to understand and interpret policies and make decisions related to eligibility determinations.
Ability to work independently; ability to work well with others as a team member.
Ability to travel locally and out-of-town for training and/or meetings.
Ability to supervise, train, and coordinate program with other eligibility/social services staff.
Ability to establish and maintain positive and effective working relationships with supervisors/co-workers and customers.

Licensure, Certification or Registration:
Must possess a valid Texas Driver’s License.  
Current and unrestricted license to practice Social Work in the State of Texas.

Initial Screening Criteria:
Bachelor's Degree in Social Work from a CSWE accredited college or university. 
Experience working within the Specialized Health and Social Services program with the Texas Department of State Health Services. 

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 for this position. For more information see the Texas State Auditor’s Military Crosswalk at https://hr.sao.texas.gov/CompensationSystem/JobDescriptions/.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), DSHS will provide reasonable accommodation during the hiring process for individuals with a qualifying disability. If reasonable accommodation is needed to participate in the interview process, please notify the person who contacts you to schedule the interview. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747 or via email at HHSServiceCenter.Applications@ngahrhosting.com.

Salary Information, Pre-employment Checks, and Work Eligibility:

• The salary offered will follow DSHS starting salary guidelines. Any employment offer is contingent upon available budgeted funds.
• Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.
• DSHS uses E-Verify. You must bring your I-9 documentation with you on your first day of work.  Download the I-9 form