Yes Waiver QM Specialist Job Listing at Texas Health and Human Services in Lubbock, TX (Job ID 13263-en_US)

Description

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.

Functional Title: Yes Waiver QM Specialist 
Job Title: Program Specialist V 
Agency: Health & Human Services Comm 
Department: BH Waivers-YES Waiver-CMH 
Posting Number: 13263 
Closing Date: 02/25/2026 
Posting Audience: Internal and External 
Occupational Category: Community and Social Services 
Salary Group: TEXAS-B-21 
Salary Range: $4,523.16 - $7,253.83 
Pay Frequency: Monthly
Shift: Day 
Additional Shift:  
Telework: Eligible for Telework 
Travel: Up to 15% 
Regular/Temporary: Regular 
Full Time/Part Time: Full time 
FLSA Exempt/Non-Exempt: Nonexempt 
Facility Location:  
Job Location City: LUBBOCK 
Job Location Address: 6302 IOLA AVE 
Other Locations: Austin 
MOS Codes: 16GX,60C0,611X,612X,63G0,641X,712X,86M0,8U000,OS,OSS,PERS,YN,YNS 
 
 
 

Program Specialist V works under the general direction of the YES Waiver QM Director with considerable latitude for use of initiative and independent judgment. Specialist functions as part of a team of staff specifically designated to work on oversight and management of Medicaid 1915(c) program, called Youth Empowerment Services (YES). The YES program is designed to allow the provision of alternative community based services to avert hospitalizations. Specialist will perform advanced (senior-level) consultative services and technical assistance work that involves working with Medicaid Policy, Forecasting, Center for Medicare and Medicaid Services(CMS) as well as community based waiver providers. Duties include: monitoring provider and authority contract and waiver compliance, clinical oversight, service delivery oversight, quality management activities, data analysis, and program evaluation, coordinating waiver renewal and amendments, program education for potential providers, and technical assistance for program providers. Specialist works closely with Quality Management, Decision Support and Medicaid areas and Centers for Medicare and Medicaid Services (CMS) to ensure compliance with the waiver and contract requirements, develop and implement program goals and objectives, leverage data including CANS/ANSA and other clinical outcomes, and other child-serving system indicators and ensure project course corrections when needed. Works closely with providers contracted to provide waiver program services to resolve problems and discuss program effectiveness.

Essential Job Functions:
1. Conducts and coordinates desk and onsite reviews to determine compliance with waiver program requirements, laws, regulations, policies, and procedures. Analyzes reviews of waiver program services and develops action plans to improve effectiveness, if needed. Communicates those findings, orally and in writing, to a wide variety of audiences, including HHSC Medicaid, local stakeholders, providers and CMS. (30%)

 2.Conducts and coordinates waiver renewal and amendments as required, and maintenance processes required for ongoing approval and operations of the waiver. (5%)

3.Develops policies and procedures related to implementation and monitoring of waiver program services. Ensures that local mental health authorities and other community based providers receive training on new policies and procedures, and that periodic monitoring takes place. (5%)

4.Ensures that there is continuous quality monitoring program in place to ensure that identified problems are acted upon and resolved promptly. Determines when course corrections are required when program or program provider is not achieving goals or objectives. (15%)

5.Collects, organizes, analyzes, and prepares material in response to requests for information from internal and external stakeholders. Synthesizes complex information for presentation to a wide variety of groups, orally and in writing. These groups consist of HHSC leadership, CMS and local stakeholders. (5%)

6.Determines trends and resolves operational problems, within HHSC and within LMHAs and/or waiver provider organizations. These consist of service delivery issues, data collection/submission issues, data entry issues, data analysis issues, invoicing processing issues (by providers), invoice processing issues (by DSHS). (10%)

7.Provides complex consultative services and technical assistance to plan, implement, and monitor waiver program services. Works closely with community based providers and local mental health authorities. (10%)

8. Assists with waiver participant plan of care reviews to authorize services within waiver requirement. (15%)

9.Performs related work as assigned. (5%)

Registrations, Licensure, Requirements or Certifications: Licensed Practitioner of the Healing Arts (LPHA) in accordance with Texas Administrative Code §412.303 MENTAL HEALTH COMMUNITY SERVICES
STANDARDS, Subchapter G preferred, not required.

Knowledge, Skills and Abilities:
Knowledge of quality assurance and monitoring processes, best practice and continuous
quality improvement.
•Familiarity with quality management activities and strategies.
•Knowledge of federal reporting guidelines.
•Knowledge of waivers and/or state plan amendments.
•Knowledge of program planning and implementation.
•Knowledge of public mental health systems.
•Knowledge of mental health issues and treatment modalities.
•Knowledge of Medicaid services.
•Ability to function effectively in a fast paced environment, to oversee/manage multiple
complex projects simultaneously, and to meet deadlines.
•Ability to exercise initiative and independent judgment.
•Ability to analyze data for completeness and accuracy and to utilize data to identify issues,
trends, and other programmatic needs.
•Ability to interact with multiple, diverse stakeholder groups.
•Ability to effectively communicate orally and in writing.

Initial Screening Criteria:  Graduation from an accredited four-year college or university with major coursework in health services, business administration, human services, social work or a related field is required. At least 2 years experience working within Medicaid or similar program(s). Experience operating or overseeing youth programs or mental health programs is preferred .Experience in quality management is preferred. 

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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 Auditor's 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.