PASRR, Provider, and Diversion… at Gulf Coast… · Texas City

THE GULF COAST CENTER PASRR, Provider, and Diversion Coordinator Team Lead II Combined Job Description: Location: Brazoria and Galveston Counties FLSA Status: Non-Exempt Working Status: Full Time with Benefits Supervision: Program Manager - IDD/PASRR and IDD Provider Services, as assigned. Position Summary: The PASRR, Provider, and Diversion Coordinator Team Lead position is essential to maintaining compliance with PASRR IDD/MI and HHSC requirements while maximizing program productivity and ensuring timely access to community-based services. The role oversees regulatory timelines, diversion activities, training, staff productivity, service delivery, provider performance, and documentation quality while reducing organizational and compliance risk. By coordinating complex PASRR, provider, and diversion functions across multiple staff, nursing facilities, contractors, and community partners, the position promotes successful community transitions, prevents unnecessary institutionalization, improves operational efficiency, increases accountability, and enables frontline staff to focus on direct service delivery and achievement of performance targets. The position also serves as a critical resource for monitoring outcomes, resolving barriers to service access, and ensuring individuals receive the most appropriate services in the least restrictive setting. This position serves as backup for the supervisor and provides coverage as needed, including completing Changes of Ownership (CHOWs) and PASRR Evaluations (PEs) to support service continuity and maximize allowable billing. PASRR Compliance and Evaluation Responsibilities: Monitor PASRR notifications daily and ensure required responses, face-to-face contacts, evaluations, meetings, services, and documentation are completed within applicable PASRR and HHSC timeframes. Complete or oversee PASRR Evaluations, including PEs, and ensure required information is entered into the TMHP portal and the electronic health record accurately and timely. Monitor PE alerts received through the TMHP portal and PASRR email and coordinate timely follow-up. Ensure required IDT meetings occur and that documentation is complete, accurate, and compliant. Monitor delivery and documentation of specialized PASRR services, including applicable TRR, Recovery Plans, monitoring, and subsequent services. Maintain communication with nursing facilities, care homes, authority staff, providers, and other partners to address individual needs and regulatory requirements. Diversion and Community Transition Responsibilities: Complete or oversee nursing-facility diversion documentation, including PL1, PE, applicable request forms, and other required transition materials. Participate in the IDT process to determine whether nursing-facility diversion or community transition is appropriate. Develop and monitor transition plans for individuals seeking community placement; identify barriers and coordinate solutions with Relocation Specialists, service coordinators, providers, nursing facilities, contractors, and community partners. Complete or coordinate pre-move and post-move site visits and required follow-up. Monitor services, safety, outcomes, and satisfaction with community placement for the required post-transition period, including 180-day monitoring when applicable. At least quarterly, provide or arrange education for nursing-facility residents and families regarding community living options. Complete required HHSC reporting regarding individuals served, diversion activity, outcomes, and barriers to community transition. Provider Services Coordination and Oversight: Coordinate and support provider services that may include respite, supported employment, community support services, day habilitation, behavioral supports, and nursing-facility services delivered by Gulf Coast Center staff, contracted providers, or voucher providers. Monitor Texas Administrative Code requirements, HHSC service definitions, billing requirements, Performance Contract measures, Medicaid practice requirements, and other applicable standards. Review PDPs and related action pages to confirm the type and amount of authorized services are referred to and delivered by internal or external providers. Discuss provider options with individuals and families, support informed provider choice, and coordinate provider assignment when internal services are selected. Authorize and monitor services delivered by providers and assigned staff within the scope of the role. Complete or oversee Implementation Plans and communicate with individuals, LARs, families, providers, and staff to individualize strategies and supports tied to identified outcomes. Review and update treatment or service plans as required and recommend changes to outcomes based on individual strengths, needs, and progress. Build and maintain relationships with nursing facilities across Brazoria and Galveston Counties and coordinate access to provider services. Monitor provider performance, service utilization, documentation quality, contract compliance, required training, credentialing, and quality of service delivery. Support procurement, initiation, and maintenance of provider contracts as backup to the supervisor, ensuring required documentation and training remain current. Complete and approve payment requisitions as backup when assigned and support SmartCare enrollment and provider-function updates. Team Leadership, Training, and Productivity: Provide day-to-day direction, coaching, mentoring, technical assistance, and positive performance feedback to PASRR, provider, and diversion staff. Coordinate staffing, workload coverage, and training so services meet HHSC, Performance Contract, Medicaid, billing, productivity, and quality requirements. Monitor staff productivity, service delivery, documentation completion, billing activity, and achievement of assigned performance targets. Identify workflow barriers, service gaps, and performance risks; coordinate corrective action and elevate unresolved concerns to the supervisor. Develop, deliver, or coordinate training for internal staff, contracted providers, voucher providers, nursing facilities, and community partners as applicable. Maintain required program tracking tools, spreadsheets, reports, quality reviews, and outcome data and communicate findings to program leadership. Complete quality-assurance reviews and use findings to strengthen compliance, documentation, service delivery, and accountability. Serve as backup to the supervisor and help maintain operational continuity during absences, vacancies, high-volume periods, or urgent service needs. Provide direct services, case coordination, or waiver-service coverage when necessary to prevent service disruption and support billing. Documentation, Data, and Billing: Complete and review programmatic, clinical, administrative, contract, and billing documentation accurately and within required timeframes. Ensure documentation is entered, scanned, routed, filed, and maintained in the appropriate systems and records. Monitor documentation to verify that services are supported, authorized, billable, and consistent with applicable requirements. Complete CHOWs, PEs, and other assigned functions to support continuity, regulatory compliance, and maximization of allowable billing. Track performance measures, provider activity, service utilization, transitions, barriers, and corrective actions and report findings to the supervisor. Organizational, Customer Service, and Compliance Standards: Treat individuals with courtesy, dignity, decency, and respect and provide responsive, efficient, person-centered services. Promote trauma-informed practices based on safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment and choice, and cultural awareness. Communicate professionally with individuals, families, LARs, staff, nursing facilities, contractors, providers, local entities, advocacy groups, and community partners. Follow Gulf Coast Center policies, the Business Code of Conduct, the Corporate Compliance Plan, safety expectations, dress code, and applicable professional, ethical, and legal requirements. Report leave, flex time, and emergency leave to the assigned supervisor. Complete special projects and other related duties within agreed timeframes. Education and Experience: High school diploma and at least three years of experience working in services for individuals with IDD, or supervisory experience that substitutes for education as permitted by organizational requirements. Bachelor's degree in a human services field is preferred. At least three years of experience working in services for individuals with IDD is preferred, including a minimum of one year of supervisory or team-lead experience. PASRR, nursing-facility, provider-services, diversion, transition, billing, contract, or quality-assurance experience is strongly preferred. Knowledge, Skills, and Abilities: Working knowledge of PASRR IDD/MI requirements, HHSC standards, Texas Administrative Code requirements, Medicaid billing, provider-service requirements, and performance measures applicable to assigned programs. Strong leadership, coaching, organization, time-management, multitasking, critical-thinking, problem-solving, and accuracy skills. Ability to prioritize competing deadlines, coordinate complex work across multiple parties, and maintain timely completion of deliverables. Ability to communicate clearly and effectively, orally and in writing, and work successfully within a team approach. Proficiency with computers, electronic health records, spreadsheets, email, and other required systems. Professionalism, accessibility, customer-service orientation, self-motivation, accountability, and respect for coworkers and individuals served. Training, Travel, and Working Conditions: Complete and maintain Center-mandated training. Role-specific training may include NEO, PCP or service-coordination training, PMAB, First Aid, and CPR, with updates or recertification as required. Work may be performed in office, field, nursing-facility, community, and remote settings, with varied or irregular hours based on program and individual needs. Travel throughout Brazoria and Galveston Counties and occasional out-of-region travel for training may be required. Maintain a current Texas driver's license, a driving record consistent with Center policy, reliable transportation, and current auto liability insurance. Work may occur in settings where communicable diseases or other environmental risks may be present. Physical and Mental Requirements: Ability to move or adjust items up to 55 pounds; ascend and descend stairs; remain stationary for extended periods; operate office equipment; and bend, twist, kneel, stoop, reach, push, pull, crawl, or squat as required. Ability to hear with or without aid, communicate and write effectively, and possess visual acuity sufficient to drive and observe the work environment. Ability to maintain regular attendance, accept constructive feedback, reason and analyze effectively, and solve practical job-related problems. Ability to work independently and closely with others in office, field, community, and potentially challenging environments. Qualified individuals must be able to perform essential functions with or without reasonable accommodation in accordance with ADA requirements.